William Beaumont Hospital, Royal Oak, Michigan, USA.
Dis Colon Rectum. 2010 Nov;53(11):1517-23. doi: 10.1007/DCR.0b013e3181f20116.
Lymph node status is important in colorectal cancer. Multiple studies indicate a relationship between the number of nodes harvested and survival. This is important in patients with stage II disease where the role of adjuvant therapy is unclear. This study sought to analyze the impact of lymph node harvest on survival in patients with stage II colorectal cancer.
The data of our hospital's colorectal tumor registry from 1997 to 2008 was reviewed. The records of 3534 patients of all stages were analyzed; of these patients, 913 patients with stage II colorectal cancer underwent curative resection. A univariate analysis estimated 5-year survival by Kaplan-Meier analysis based on various lymph node groupings. Patients were further analyzed with respect to sex, age, tumor grade, and tumor location. Multivariate linear regression analysis by the Cox proportional hazards model was performed using these variables to analyze survival relative to lymph node harvesting.
Of 913 stage II patients, the mean age was 71 years and 48% were male. Univariate analysis of the number of lymph nodes harvested found that ≥24 nodes removed was a significant and independent factor for improved survival in stage II (P = .009) and ≥36 nodes in stage III cancers (P = .008). Cox proportional hazards ratios found male sex (P < .03) and poorly differentiated tumors (P < .015) to be negative independent risk factors for survival. Tumor location in the sigmoid was associated with improved survival (P < .02).
Patients with stage II disease had an improved survival when ≥24 lymph nodes were harvested, and patients with stage III disease had improved survival with up to a 36 node harvest. Male sex and poorly differentiated tumors had a worse prognosis, and tumors located in the sigmoid were associated with improved survival in stage II cancers. An increased lymph node harvest is recommended to improve survival in these stages.
淋巴结状态在结直肠癌中很重要。多项研究表明，淋巴结检出数目与生存之间存在关系。这在辅助治疗作用尚不明确的 II 期疾病患者中尤为重要。本研究旨在分析 II 期结直肠癌患者淋巴结检出数目对生存的影响。
我们医院的结直肠肿瘤登记处的 1997 年至 2008 年的数据进行了回顾性分析。分析了所有分期的 3534 例患者的记录；其中 913 例 II 期结直肠癌患者接受了根治性切除术。通过 Kaplan-Meier 分析对各种淋巴结分组进行单变量分析，估计 5 年生存率。进一步根据性别、年龄、肿瘤分级和肿瘤部位对患者进行分析。使用 Cox 比例风险模型进行多变量线性回归分析，分析淋巴结清扫与生存的关系。
913 例 II 期患者的平均年龄为 71 岁，48%为男性。对检出淋巴结数量的单变量分析发现，II 期患者检出≥24 个淋巴结和 III 期患者检出≥36 个淋巴结是提高生存率的显著独立因素（P =.009 和 P =.008）。Cox 比例风险比发现男性（P <.03）和低分化肿瘤（P <.015）是生存的负面独立危险因素。乙状结肠肿瘤位置与生存改善相关（P <.02）。
II 期患者检出≥24 个淋巴结可提高生存率，III 期患者检出≥36 个淋巴结可提高生存率。男性和低分化肿瘤预后较差，II 期乙状结肠肿瘤与生存改善相关。建议增加淋巴结清扫以提高这些分期的生存率。
