Rosenberg Robert, Friederichs Jan, Schuster Tibor, Gertler Ralf, Maak Matthias, Becker Karen, Grebner Anne, Ulm Kurt, Höfler Heinz, Nekarda Hjalmar, Siewert Jörg-Rüdiger
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Ann Surg. 2008 Dec;248(6):968-78. doi: 10.1097/SLA.0b013e318190eddc.
We examined the prognostic impact of lymph node ratio (relation of tumor-infiltrated to resected lymph nodes) in comparison to the pN category and other prognostic factors in patients with colorectal cancer.
Although the high prognostic impact of lymph node metastases and the total number of lymph nodes to be resected are well established, studies still report large differences in lymph node numbers. The lymph node ratios relevant for prognosis are not clearly defined and not routinely reported.
We analyzed the clinical and histopathological data of 3026 patients with colorectal cancer at a single surgical center over a 25-year time period (1982-2006).
One thousand seven hundred sixty-three colon and 1263 rectal carcinomas were documented. The rate of curative resection was 77.4% and the median number of resected lymph nodes was 16. The optimal cut-off values for prognostic differentiation of LNRs were statistically calculated as 0.17, 0.41, and 0.69. The 5-year overall survival of patients without lymph node metastases was 87%. Patients with lymph node metastases had 5-year overall survival rates of 60.6%, 34.4%, 17.6%, and 5.3% with increasing LNRs (P < 0.001). Multivariate survival analysis identified both the LNR and the pN category, the number of resected lymph nodes, the patient's age, the tumor location (colon vs. rectum), the pT category, the pM status, the R status, the tumor grade, and the year of operation as independent prognostic factors. The LNR had better prognostic value than the pN category (P < 0.05). The analysis of the subgroup of patients separated into colon and rectal cancer patients confirmed the identified LNRs as independent prognostic factors (P < 0.001).
The defined cut-off values of LNRs were strong independent prognostic factors for colorectal cancer patients and should be calculated for risk group stratification.
我们研究了淋巴结比率（肿瘤浸润淋巴结与切除淋巴结的关系）与pN分类及其他预后因素相比，对结直肠癌患者的预后影响。
尽管淋巴结转移的高预后影响以及需切除的淋巴结总数已得到充分证实，但研究仍报告淋巴结数量存在很大差异。与预后相关的淋巴结比率尚未明确界定，也未常规报告。
我们分析了一家单一外科中心在25年时间（1982 - 2006年）内3026例结直肠癌患者的临床和组织病理学数据。
记录了1763例结肠癌和1263例直肠癌。根治性切除率为77.4%，切除淋巴结的中位数为16个。通过统计学计算得出，用于LNRs预后分化的最佳临界值为0.17、0.41和0.69。无淋巴结转移患者的5年总生存率为87%。随着LNRs升高，有淋巴结转移患者的5年总生存率分别为60.6%、34.4%、17.6%和5.3%（P < 0.001）。多因素生存分析确定LNR、pN分类、切除淋巴结数量、患者年龄、肿瘤部位（结肠与直肠）、pT分类、pM状态、R状态、肿瘤分级和手术年份均为独立预后因素。LNR的预后价值优于pN分类（P < 0.05）。对分为结肠癌和直肠癌患者的亚组分析证实，所确定的LNRs为独立预后因素（P < 0.001）。
所定义的LNRs临界值是结直肠癌患者强有力的独立预后因素，应计算这些值用于风险组分层。
