State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.
Ann Surg Oncol. 2011 Jun;18(6):1568-74. doi: 10.1245/s10434-010-1528-8. Epub 2011 Jan 5.
The objective of this study was to assess the value of metastatic lymph node ratio in predicting prognosis of patients with stage III colorectal cancer.
From 2000 to 2005 inclusively, a total of 626 patients featuring stage III colorectal cancer underwent curative resection. These patients were stratified into LNR groups: 1 (0 < LNR ≤ 0.1); 2 (0.1 < LNR ≤ 0.25); 3 (0.25 < LNR ≤ 0.5); and 4 (LNR > 0.5). The follow-up was closed in April 2010. Kaplan-Meier survival curve and log-rank test were used to evaluate the prognostic value of LNR. A Cox regression model was used for multivariate analyses.
With a median follow-up period of 42.2 months, 5-year overall survival for groups LNR1, LNR2, LNR3, and LNR4 was 73%, 64%, 44%, and 22%, respectively. In the multivariate analysis, the LNR was an independent prognostic factor for survival (P < 0.001). LNR remained statistically significant (P < 0.001), both in patients with colon and rectum cancer regardless of the number of lymph nodes retrieved (≥12 or < 12). The survival rate of ratio group LNR1 was better than ratio group LNR4 (P < 0.001) for patients with the same IIIB or IIIC staging.
LNR is an accurate prognostic method for patients with stage III colorectal cancer. We proposed an algorithm to incorporate LNR into current AJCC staging system to form new staging.
本研究旨在评估转移淋巴结比率在预测 III 期结直肠癌患者预后中的价值。
本研究纳入了 2000 年至 2005 年期间接受根治性切除术的 626 例 III 期结直肠癌患者。根据淋巴结转移率（LNR）分为 LNR1 组（0＜LNR≤0.1）、LNR2 组（0.1＜LNR≤0.25）、LNR3 组（0.25＜LNR≤0.5）和 LNR4 组（LNR＞0.5）。随访截至 2010 年 4 月。采用 Kaplan-Meier 生存曲线和对数秩检验评估 LNR 的预后价值，采用 Cox 回归模型进行多因素分析。
中位随访时间为 42.2 个月，LNR1、LNR2、LNR3 和 LNR4 组的 5 年总生存率分别为 73%、64%、44%和 22%。多因素分析显示，LNR 是影响生存的独立预后因素（P＜0.001）。LNR 仍然是统计学上显著的预后因素（P＜0.001），无论淋巴结检出数量（≥12 或＜12）如何。对于相同的 IIIB 或 IIIC 分期的患者，LNR1 组的生存率优于 LNR4 组（P＜0.001）。
LNR 是预测 III 期结直肠癌患者预后的准确方法。我们提出了一种将 LNR 纳入当前 AJCC 分期系统的算法，以形成新的分期。
