Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
Ann Surg Oncol. 2009 Nov;16(11):3080-6. doi: 10.1245/s10434-009-0620-4. Epub 2009 Jul 28.
Improved survival is associated with an increased number of lymph nodes (LNs) examined. The aim of this study was to assess whether the examination of >or=12 LNs is associated with more accurate colon cancer staging.
We queried the Department of Defense Automated Central Tumor Registry database for stage I-III colon cancer patients. Logistic regression analysis was performed to determine whether the examination of >or=12 LNs is associated with increased rates of LN-positive colon cancer. Kaplan-Meier and Cox proportional hazard analysis was performed to evaluate the effect of number of LNs examined on survival.
The rate of LN-positive colon cancer is significantly higher with increasing number of LNs examined (1-3 LNs examined: 31% vs. >12 LNs examined: 41%, P<.001). Logistic regression analysis adjusting for patients, tumor, and hospital characteristics showed that examination of >or=12 LNs is associated with a >30% increase in detecting a LN-positive colon cancer (odds ratio, 1.350; 95% confidence interval, 1.175-1.511). The evaluation of >or=12 LNs is associated with improved survival in LN-negative colon cancer patients (P<.001).
Our study demonstrates that the proportion of LN-positive colon cancer is far higher when >or=12 LNs are examined. Examination of >or=12 LNs may improve staging accuracy and outcome with optimal use of systemic chemotherapy.
生存时间的延长与检查的淋巴结（LNs）数量增加有关。本研究旨在评估检查>或=12 个淋巴结是否与更准确的结肠癌分期相关。
我们在国防部自动中央肿瘤登记数据库中查询了 I-III 期结肠癌患者的数据。使用逻辑回归分析来确定检查>或=12 个淋巴结是否与 LN 阳性结肠癌的增加率相关。Kaplan-Meier 和 Cox 比例风险分析用于评估检查的淋巴结数量对生存的影响。
随着检查的淋巴结数量增加，LN 阳性结肠癌的比例显著升高（1-3 个淋巴结检查：31%；>12 个淋巴结检查：41%，P<.001）。调整患者、肿瘤和医院特征的逻辑回归分析表明，检查>或=12 个淋巴结可使检测 LN 阳性结肠癌的概率增加>30%（比值比，1.350；95%置信区间，1.175-1.511）。检查>或=12 个淋巴结与 LN 阴性结肠癌患者的生存改善相关（P<.001）。
我们的研究表明，当检查>或=12 个淋巴结时，LN 阳性结肠癌的比例要高得多。检查>或=12 个淋巴结可能会提高分期的准确性，并通过优化使用系统化疗来改善预后。
