Derwinger K, Carlsson G, Gustavsson B
Department of Surgery, Sahlgrenska University Hospital/Ostra, 41685 Gothenburg, Sweden.
Eur J Surg Oncol. 2008 Jul;34(7):771-5. doi: 10.1016/j.ejso.2007.11.002. Epub 2008 Feb 20.
The aim of this study was to evaluate and describe the lymph node ratio (LNR) as a prognostic parameter for patients with colon cancer. As lymphatic involvement is the key, focus was set at stage III disease. Interest was directed at the possibility of identifying high-risk groups and the clinical implementation and consequence.
The study was retrospective using a database of clinical data of all cancer patients treated at our unit. It has been continuous in registration, inclusion and update since 1999 including survival and clinical features. All patients (n=265) diagnosed with stage III colon cancer during 1999-2003 were included for the study. LNR was calculated and quartile groups were created. LNR and associated parameters were analysed towards 3-year disease-free survival (DFS). Basic patient data as well as surgery, pathology and postoperative treatment were taken into consideration.
Significant differences in disease-free survival were found for TNM N-status, tumour differentiation grade and LNR quartile group. There was a difference in 3-year DFS from 80% in LNR group 1 compared with less than 30% in group 4. These results were of prognostic interest both independently and in interaction with each other. High-risk groups could be identified and in the worst prognosis LNR group we also found a tendency towards more side effects with adjuvant chemotherapy.
The lymph node ratio, the quota between the number of lymph node metastasis and assessed lymph nodes, is a highly significant (p<0.001) prognostic factor in stage III colon cancer. It can be an aid in identifying risk groups that could benefit from a more intense postoperative surveillance and possibly bring changes in adjuvant treatment strategy. More studies of clinical data, genetic and biochemical markers are needed in this patient group to understand the possible difference in tumour behaviour and tailor the treatment.
本研究旨在评估和描述淋巴结比率（LNR）作为结肠癌患者的一个预后参数。由于淋巴受累是关键因素，研究重点设定在III期疾病。研究兴趣在于识别高危组的可能性以及临床应用和影响。
本研究为回顾性研究，使用了我们科室所有癌症患者的临床数据库。自1999年以来，该数据库一直在持续进行登记、纳入和更新，包括生存情况和临床特征。纳入了1999年至2003年期间诊断为III期结肠癌的所有患者（n = 265）进行研究。计算LNR并创建四分位数组。分析LNR及相关参数与3年无病生存率（DFS）的关系。考虑了患者的基本数据以及手术、病理和术后治疗情况。
在TNM N分期、肿瘤分化程度和LNR四分位数组之间，无病生存率存在显著差异。LNR第1组的3年DFS为80%，而第4组则低于30%。这些结果无论是单独来看还是相互作用时都具有预后意义。可以识别出高危组，在预后最差的LNR组中，我们还发现辅助化疗有更多副作用的趋势。
淋巴结比率，即淋巴结转移数量与评估的淋巴结数量之比，是III期结肠癌中一个高度显著（p<0.001）的预后因素。它有助于识别可能从更强化的术后监测中获益的风险组，并可能带来辅助治疗策略的改变。对于该患者群体，需要更多关于临床数据、基因和生化标志物的研究，以了解肿瘤行为的可能差异并调整治疗方案。
