Department of Colorectal Surgery Department of Pathology, Royal Liverpool University Hospital NHS Trust, Liverpool, UK.
Colorectal Dis. 2011 May;13(5):526-31. doi: 10.1111/j.1463-1318.2010.02188.x.
The prognostic significance of apical node metastasis in node-positive colorectal cancer (CRC) is disregarded by the Fourth American Joint Committee on Cancer and the International Union Against Cancer (AJCC/UICC) TNM classification system. The influence of apical node metastases on overall 5-year survival among patients with Dukes stage C CRC was examined.
Patients who underwent operative resection for CRC between 1999 and 2003 were reviewed.
Two-hundred and ninety patients were included in the study, including 203 with Dukes C apical node-negative cancers, 39 with Dukes C apical node-positive cancers and 48 with Dukes D cancers. The respective prevalence of extramural vascular invasion was 35%vs 64%vs 56% (P = 0.0005), T4-stage 24%vs 38%vs 48% (P = 0.013), positive resection margin 16%vs 41%vs 23% (P = 0.001), more than three positive nodes harvested 28%vs 85%vs 52% (P < 0.0001) and poorer tumour differentiation grade 9%vs 21%vs 23% (P = 0.009). Multivariate analyses of all Dukes C cancer patients (n = 242) showed a positive apical node to be a highly significant independent predictor of mortality (hazard ratio 2.281, 95% confidence interval 1.421-3.662, P = 0.0006). Extramural vascular invasion and a positive resection margin were also independent predictors of poor survival. Patients with Dukes C apical node-positive cancers had a significantly poorer overall 5-year survival compared to patients with Dukes C apical node-negative cancers (P < 0.0001) but survival was not significantly different compared to patients with distant metastases at initial presentation (P = 0.504).
Apical node metastasis appears to be a strong independent, negative prognostic factor of poor survival in Dukes C CRC.
第四版美国癌症联合委员会（AJCC）和国际抗癌联盟（UICC）TNM 分类系统忽略了阳性淋巴结结直肠癌（CRC）中尖部淋巴结转移的预后意义。本研究旨在研究尖部淋巴结转移对 Dukes C 期 CRC 患者总 5 年生存率的影响。
回顾性分析 1999 年至 2003 年间接受 CRC 手术切除的患者。
本研究共纳入 290 例患者，其中 203 例 Dukes C 期尖部淋巴结阴性癌症，39 例 Dukes C 期尖部淋巴结阳性癌症，48 例 Dukes D 期癌症。相应的外膜血管侵犯发生率分别为 35%vs 64%vs 56%（P = 0.0005），T4 期分别为 24%vs 38%vs 48%（P = 0.013），阳性切缘分别为 16%vs 41%vs 23%（P = 0.001），阳性淋巴结清扫分别为 28%vs 85%vs 52%（P < 0.0001），肿瘤分化程度较差分别为 9%vs 21%vs 23%（P = 0.009）。对所有 Dukes C 期癌症患者（n = 242）进行多因素分析，发现阳性尖部淋巴结是死亡率的一个非常显著的独立预测因素（风险比 2.281，95%置信区间 1.421-3.662，P = 0.0006）。外膜血管侵犯和阳性切缘也是不良生存的独立预测因素。与 Dukes C 期尖部淋巴结阴性癌症患者相比，Dukes C 期尖部淋巴结阳性癌症患者的总体 5 年生存率显著降低（P < 0.0001），但与初诊时远处转移的患者相比，生存率无显著差异（P = 0.504）。
在 Dukes C 期 CRC 中，尖部淋巴结转移似乎是预后不良的一个独立的、强烈的负性预后因素。
