淋巴结转移的分布是影响乙状结肠和直肠癌患者生存的独立预测因子。

Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer.

机构信息

Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea.

出版信息

Ann Surg. 2012 Jan;255(1):70-8. doi: 10.1097/SLA.0b013e31823785f6.

DOI:10.1097/SLA.0b013e31823785f6

PMID:22133895

Abstract

OBJECTIVE

This study evaluated the prognostic significance of the distribution of lymph node metastases (LND) in patients with colorectal cancer.

BACKGROUND

The impact of the LND on survival in colorectal cancer is unknown.

METHODS

A total of 1205 consecutive patients who underwent potentially curative surgery for sigmoid colon or rectal cancer with high ligation of the inferior mesenteric artery (IMA) from January 1997 to February 2008 were assigned to 4 groups based on LND: LND0, no lymph node metastases-615 patients (51.0%); LND1, metastases in the pericolic nodes-324 patients (26.9%); LND2, metastases in the intermediate nodes-172 patients (14.3%); and LND3, node metastases at the origin of the IMA-94 patients (7.8%).

RESULTS

The 5-year overall survival rates of patients with LND0, LND1, LND2, and LND3 were 83%, 63%, 52%, and 28%, respectively (P < 0.001). The 5-year disease-free survival rates of patients with LND0, LND1, LND2, and LND3 were 83%, 54%, 43%, and 21%, respectively (P < 0.001). On multivariate analysis, LND was an independent prognostic factor for both overall survival and disease-free survival. However, the 5-year local recurrence-free survival rate was not inversely related to the LND. On a subset analysis that compared stage III disease with stage IV disease, the 5-year overall survival and disease-free survival rates were 45% and 31% for the patients with stage IV disease compared with 40% and 32% for the patients with stage III, LND3 disease, respectively (P = 0.761 and 0.704). For the patients with pN1 tumors, the overall survival and disease-free survival did not differ significantly according to the LND (P = 0.471 and 0.347, respectively). However, for patients with pN2 tumors, the overall survival and disease-free survival curves among the LND groups significantly differed (P < 0.001 and <0.001, respectively).

CONCLUSION

LND is an independent predictor of survival for colorectal cancer patients, but it does not predict local recurrence. The N categorization including LND may enhance the prognostic value of the TNM staging system for patients with node-positive sigmoid colon or rectal cancer.

摘要

目的

本研究评估了结直肠癌患者淋巴结转移（LND）分布的预后意义。

背景

LND 对结直肠癌患者生存的影响尚不清楚。

方法

1997 年 1 月至 2008 年 2 月，对 1205 例接受高结扎肠系膜下动脉（IMA）的乙状结肠或直肠潜在根治性手术的连续患者进行分组，根据 LND 分为 4 组：LND0，无淋巴结转移-615 例（51.0%）；LND1，结肠旁淋巴结转移-324 例（26.9%）；LND2，中间淋巴结转移-172 例（14.3%）；LND3，IMA 起源处淋巴结转移-94 例（7.8%）。

结果

LND0、LND1、LND2 和 LND3 患者的 5 年总生存率分别为 83%、63%、52%和 28%（P<0.001）。LND0、LND1、LND2 和 LND3 患者的 5 年无病生存率分别为 83%、54%、43%和 21%（P<0.001）。多因素分析显示，LND 是总生存和无病生存的独立预后因素。然而，5 年局部无复发生存率与 LND 无反比关系。在比较 IV 期和 IV 期疾病的亚组分析中，IV 期疾病患者的 5 年总生存率和无病生存率分别为 45%和 31%，而 III 期、LND3 疾病患者分别为 40%和 32%（P=0.761 和 0.704）。对于 pN1 肿瘤患者，LND 对总生存率和无病生存率无显著差异（P=0.471 和 0.347）。然而，对于 pN2 肿瘤患者，LND 组的总生存率和无病生存率曲线明显不同（P<0.001 和 <0.001）。