Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi-ken 320-0834, Japan.
Jpn J Clin Oncol. 2012 Jan;42(1):29-35. doi: 10.1093/jjco/hyr164. Epub 2011 Nov 18.
The number of lymph nodes retrieved is recognized to be a prognostic factor of Stage II colorectal cancer. However, the prognostic significance of the number of lymph nodes retrieved in Stage III colorectal cancer remains controversial.
The relationship between the number of lymph nodes retrieved and clinical and pathological factors, and significance of the number of lymph nodes retrieved for prognosis of Stage II and III colorectal cancer were investigated. A total of 16 865 patients with T3/T4 colorectal cancer who had R0 resection were analysed.
The arithmetic mean of the number of lymph nodes retrieved of all cases was 20.0. The number of lymph nodes retrieved were varied according to several clinical and pathological variables with significant difference, and the greater difference was observed in scope of nodal dissection. Survival of Stages II and III was significantly associated with the number of lymph nodes retrieved. Five-year overall survival of the patients with ≤ 9 of the number of lymph nodes retrieved and those with >27 differed by 6.4% for Stage II colon cancer, 8.8% for Stage III colon cancer, 12.5% for Stage II rectal cancer and 10.6% for Stage III rectal cancer. With one increase in the number of lymph nodes retrieved, the mortality risk was decreased by 2.1% for Stage II and by 0.8% for Stage III, respectively. The cut-off point of the number of lymph nodes retrieved was not obtained.
The number of lymph nodes retrieved was shown to be an important prognostic variable not only in Stage II but also in Stage III colorectal cancer, and it was most prominently determined by the scope of nodal dissection. A cut-off value for the number of lymph nodes retrieved was not found, and it is necessary to carry out appropriate nodal dissection and examine as many lymph nodes as possible.
淋巴结检出数目已被确认为结直肠癌Ⅱ期的预后因素。然而，在结直肠癌Ⅲ期，淋巴结检出数目对预后的预测价值仍存在争议。
研究了淋巴结检出数目与临床病理因素的关系，以及其对Ⅱ期和Ⅲ期结直肠癌预后的意义。共分析了 16865 例接受 R0 切除的 T3/T4 结直肠癌患者。
所有病例的淋巴结检出数算术平均值为 20.0。淋巴结检出数因几种临床病理变量而异，差异有统计学意义，淋巴结清扫范围的差异最大。Ⅱ期和Ⅲ期的生存与淋巴结检出数显著相关。Ⅱ期结肠癌淋巴结检出数≤9 枚和>27 枚的患者 5 年总生存率相差 6.4%，Ⅲ期结肠癌相差 8.8%，Ⅱ期直肠癌相差 12.5%，Ⅲ期直肠癌相差 10.6%。每增加一个淋巴结的检出，Ⅱ期和Ⅲ期的死亡风险分别降低 2.1%和 0.8%。未获得淋巴结检出数的截断值。
淋巴结检出数不仅在Ⅱ期，而且在Ⅲ期结直肠癌中也是一个重要的预后变量，其主要由淋巴结清扫范围决定。未发现淋巴结检出数的截断值，有必要进行适当的淋巴结清扫并尽可能检查更多的淋巴结。
