Peng Junjie, Xu Ye, Guan Zuqing, Zhu Ji, Wang Minghe, Cai Guoxiang, Sheng Weiqi, Cai Sanjun
Department of Colorectal Surgery, Cancer Hospital, Fudan University, 270 Dong An Road, Shanghai 200032, People's Republic of China.
Ann Surg Oncol. 2008 Nov;15(11):3118-23. doi: 10.1245/s10434-008-0123-8. Epub 2008 Sep 3.
The purpose of the study was to evaluate the prognostic value of metastatic lymph node ratio (LNR) in node-positive rectal cancer.
A retrospective review was performed in 318 rectal cancer patients who received curative anterior resection in a single institution. Clinicopathological variables including LNR were studied in univariate and multivariate analyses by Cox regression. LNR was further studied when stratified by quartiles. Survival analyses were performed using the Kaplan-Meier method and log-rank test.
With median follow-up of 41 months, the 5-year disease-free survival (DFS) rate, overall survival (OS) rate, and local recurrence (LR) rate were 56.82%, 59.8%, and 11%, respectively. Multivariate analysis revealed that LNR as a continuous variable was the most significant prognostic factor for DFS, OS, and LR. On quartiles, LNR was stratified into three groups: <0.14, 0.14-0.49, and 0.5-1. The 5-year DFS rate was 72.57%, 58.54%, and 34.75% (P = 0.0001) and the 5-year OS rate was 72.19%, 61.92%, and 38.47% (P = 0.002) in the three groups, respectively. Five-year LR rate was significantly higher with LNR between 0.14 and 1 (3.6% in LNR<0.14 versus 15.6% in LNR 0.14-1, P = 0.019).
LNR is an important prognostic factor for node-positive rectal cancers. With a cutoff of 0.14 and 0.5, node-positive rectal cancer patients could be categorized into three subsets with significant different outcomes.
本研究旨在评估转移淋巴结比率（LNR）在淋巴结阳性直肠癌中的预后价值。
对在单一机构接受根治性前切除术的318例直肠癌患者进行回顾性研究。通过Cox回归对包括LNR在内的临床病理变量进行单因素和多因素分析。按四分位数分层进一步研究LNR。采用Kaplan-Meier法和对数秩检验进行生存分析。
中位随访41个月，5年无病生存率（DFS）、总生存率（OS）和局部复发率（LR）分别为56.82%、59.8%和11%。多因素分析显示，作为连续变量的LNR是DFS, OS和LR的最显著预后因素。按四分位数，LNR分为三组：<0.14、0.14 - 0.49和0.5 - 1。三组的5年DFS率分别为72.57%、58.54%和34.75%（P = 0.0001），5年OS率分别为72.19%、61.92%和38.47%（P = 0.002）。LNR在0.14至1之间时，5年LR率显著更高（LNR<0.14时为3.6%，LNR 0.14 - 1时为15.6%，P = 0.019）。
LNR是淋巴结阳性直肠癌的重要预后因素。以0.14和0.5为临界值，淋巴结阳性直肠癌患者可分为三个预后显著不同的亚组。
