Tsikitis Vassiliki L, Larson David L, Wolff Bruce G, Kennedy Gregory, Diehl Nancy, Qin Rui, Dozois Eric J, Cima Robert R
Division of Colorectal Surgery, Mayo Clinic, Rochester, MN, USA.
J Am Coll Surg. 2009 Jan;208(1):42-7. doi: 10.1016/j.jamcollsurg.2008.10.013.
Retrieval of >/= 12 lymph nodes has been set as a marker of quality for surgical resection for colon cancer. The aim of our study was to determine if increasing the number of lymph nodes recovered in stage III colon cancer results in improved survival and if it does represent a reasonable quality metric.
Data from patients with stage III colon cancer from 1996 to 2001 were analyzed. Outcomes after operation (cancer-specific survival, disease-free survival, and overall survival) with or without adjuvant therapy were evaluated in 3 categories: the entire cohort, patients with N1, and patients with N2 disease. These categories were then classified into subgroups by the number of nodes (</= 12 versus >12) retrieved per specimen and whether they had 5-FU-based chemotherapy or not.
Three hundred twenty-nine patients, with a median followup of 5 years with stage III colon cancer, were identified. Five-year cancer-specific and disease-free survival was 67.2% and 59.7%, respectively. A positive correlation between number of positive lymph nodes and overall survival was found (p < 0.05). No significant association was observed between the total number (> 12 versus </= 12) of lymph nodes removed either in the entire cohort or in patients with N1 (249 patients) and N2 (80 patients) disease.
Accurate staging requires an appropriate operation and a concerted pathologic effort to identify lymph nodes in the colon specimen. The total number of lymph nodes analyzed for stage III colon cancer is not a prognostic indicator of cancer-specific and disease-free survival.
切除≥12枚淋巴结已被设定为结肠癌手术切除质量的一个指标。我们研究的目的是确定增加III期结肠癌回收淋巴结的数量是否会改善生存率，以及它是否确实代表一个合理的质量指标。
分析了1996年至2001年III期结肠癌患者的数据。对接受或未接受辅助治疗的术后结果（癌症特异性生存、无病生存和总生存）按3类进行评估：整个队列、N1期患者和N2期患者。然后根据每个标本回收的淋巴结数量（≤12枚与>12枚）以及是否接受基于5-氟尿嘧啶的化疗将这些类别分为亚组。
确定了329例III期结肠癌患者，中位随访时间为5年。5年癌症特异性生存率和无病生存率分别为67.2%和59.7%。发现阳性淋巴结数量与总生存之间存在正相关（p<0.05）。在整个队列或N1期（249例患者）和N2期（80例患者）疾病患者中，切除的淋巴结总数（>12枚与≤12枚）之间未观察到显著关联。
准确分期需要适当的手术和一致的病理努力以识别结肠标本中的淋巴结。III期结肠癌分析的淋巴结总数不是癌症特异性生存和无病生存的预后指标。
