Ceelen W, Van Nieuwenhove Y, Pattyn P
Department of Gastrointestinal Surgery, University Hospital, De Pintelaan 185, Ghent, Belgium.
Ann Surg Oncol. 2010 Nov;17(11):2847-55. doi: 10.1245/s10434-010-1158-1. Epub 2010 Jun 18.
Although nodal invasion represents one of the most powerful prognostic indicators in colorectal cancer, marked heterogeneity exists within stage III patients. Recently, the lymph node ratio (LNR), defined as the ratio of the number of positive nodes over the total number of examined nodes, was proposed to stratify outcome in stage III patients.
A systematic search was performed for studies examining the prognostic significance of the LNR in colon or rectal cancer. Individual studies were assessed for methodological quality and summary data extracted. Hazard ratios from multivariate analyses were entered in a fixed-effects meta-analysis model.
In total, 16 studies were identified including 33,984 patients with stage III colon or rectal cancer. In all identified studies, the LNR was identified as an independent prognostic factor in patients with stage III cancer of the colon or rectum. The prognostic separation obtained by the LNR was superior to that of the number of positive nodes (N stage). The pooled hazard ratios for overall and disease-free survival were 2.36 (95% confidence interval, 2.14-2.61) and 3.71 (95% confidence interval, 2.56-5.38), respectively.
The LNR allows superior prognostic stratification in stage III colorectal cancer and should be validated in prospective studies.
尽管淋巴结转移是结直肠癌最重要的预后指标之一，但III期患者中存在明显的异质性。最近，提出了淋巴结转移率（LNR），定义为阳性淋巴结数与检查的淋巴结总数之比，用于对III期患者的预后进行分层。
对研究LNR在结肠癌或直肠癌中预后意义的研究进行系统检索。对各个研究的方法学质量进行评估，并提取汇总数据。将多变量分析中的风险比纳入固定效应荟萃分析模型。
共纳入16项研究，包括33984例III期结肠癌或直肠癌患者。在所有纳入的研究中，LNR被确定为III期结肠癌或直肠癌患者的独立预后因素。LNR获得的预后分层优于阳性淋巴结数（N分期）。总生存和无病生存的合并风险比分别为2.36（95%置信区间，2.14 - 2.61）和3.71（95%置信区间，2.56 - 5.38）。
LNR能对III期结直肠癌进行更好的预后分层，应在前瞻性研究中进行验证。
