Wind J, ten Kate F J W, Kiewiet J J S, Lagarde S M, Slors J F M, van Lanschot J J B, Bemelman W A
Department of Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
Eur J Surg Oncol. 2008 Apr;34(4):390-6. doi: 10.1016/j.ejso.2007.05.011. Epub 2007 Jul 5.
In colonic cancer the prognostic significance of extracapsular lymph node involvement (LNI) is not established and is therefore the objective of this study.
Between January 1994 and May 2005, all patients who underwent resection for primary colonic cancer with lymph node metastasis were reviewed. All resected lymph nodes were re-examined to assess extracapsular LNI. In uni- and multivariate analysis disease-free survival (DFS) was correlated with various clinicopathologic factors.
One hundred and eleven patients were included. In 58 patients extracapsular LNI was identified. Univariate analysis revealed that pN-stage (5-year DFS pN1 vs. pN2: 65% vs. 14%, p<0.001), extracapsular LNI (5-year DFS intracapsular LNI vs. extracapsular LNI: 69% vs. 41%, p=0.003), and lymph node ratio (5-year DFS <0.176 vs. > or =0.176: 67% vs. 42%, p=0.023) were significant prognostic indicators. Among these variables pN-stage (hazard ratio 3.5, 95% confidence interval [CI]: 1.72-7.42) and extracapsular LNI (hazard ratio 1.98, 95% CI: 1.00-3.91) were independent prognostic factors. Among patients without extracapsular LNI, those receiving adjuvant chemotherapy had a significantly better survival (p=0.010). In contrast, chemotherapy did not improve DFS in patients with extracapsular LNI.
Together with pN2 stage, extracapsular LNI reflects a particularly aggressive behaviour and has significant prognostic potential.
在结肠癌中，包膜外淋巴结受累（LNI）的预后意义尚未明确，因此本研究以此为目标。
回顾1994年1月至2005年5月间所有因原发性结肠癌伴淋巴结转移而接受手术切除的患者。对所有切除的淋巴结进行重新检查以评估包膜外LNI。在单因素和多因素分析中，无病生存期（DFS）与各种临床病理因素相关。
共纳入111例患者。58例患者发现有包膜外LNI。单因素分析显示，pN分期（5年DFS，pN1 对 pN2：65% 对 14%，p<0.001）、包膜外LNI（5年DFS，包膜内LNI对包膜外LNI：69% 对 41%，p=0.003）和淋巴结比率（5年DFS，<0.176 对 ≥0.176：67% 对 42%，p=0.023）是显著的预后指标。在这些变量中，pN分期（风险比3.5，95%置信区间[CI]：1.72 - 7.42）和包膜外LNI（风险比1.98，95%CI：1.00 - 3.91）是独立的预后因素。在没有包膜外LNI的患者中，接受辅助化疗的患者生存期显著更好（p=0.010）。相反，化疗并未改善有包膜外LNI患者的DFS。
与pN2期一样，包膜外LNI反映了一种特别侵袭性的行为，具有显著的预后潜力。
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