Department of Surgery, Laboratory for Surgical Research, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
BMC Gastroenterol. 2012 Mar 23;12:24. doi: 10.1186/1471-230X-12-24.
Lymphadenectomy is performed to assess patient prognosis and to prevent metastasizing. Recently, it was questioned whether lymph node metastases were capable of metastasizing and therefore, if lymphadenectomy was still adequate. We evaluated whether the nodal status impacts on the occurrence of distant metastases by analyzing a highly selected cohort of colon cancer patients.
1,395 patients underwent surgery exclusively for colon cancer at the University of Lübeck between 01/1993 and 12/2008. The following exclusion criteria were applied: synchronous metastasis, R1-resection, prior/synchronous second carcinoma, age < 50 years, positive family history, inflammatory bowel disease, FAP, HNPCC, and follow-up < 5 years. The remaining 421 patients were divided into groups with (TM+, n = 75) or without (TM-, n = 346) the occurrence of metastasis throughout a 5-year follow-up.
Five-year survival rates for TM + and TM- were 21% and 73%, respectively (p < 0.0001). Survival rates differed significantly for N0 vs. N2, grading 2 vs. 3, UICC-I vs. -II and UICC-I vs. -III (p < 0.05). Regression analysis revealed higher age upon diagnosis, increasing N- and increasing T-category to significantly impact on recurrence free survival while increasing N-and T-category were significant parameters for the risk to develop metastases within 5-years after surgery (HR 1.97 and 1.78; p < 0.0001).
Besides a higher T-category, a positive N-stage independently implies a higher probability to develop distant metastases and correlates with poor survival. Our data thus show a prognostic relevance of lymphadenectomy which should therefore be retained until conclusive studies suggest the unimportance of lmyphadenectomy.
淋巴结切除术是为了评估患者的预后和预防转移。最近，有人质疑淋巴结转移是否具有转移能力，因此，淋巴结切除术是否仍然足够。我们通过分析一组高度选择的结肠癌患者，评估了淋巴结状态是否会影响远处转移的发生。
1993 年 1 月至 2008 年 12 月，吕贝克大学的 1395 例患者仅因结肠癌接受手术。以下排除标准适用：同步转移、R1 切除术、先前/同步第二癌、年龄 < 50 岁、阳性家族史、炎症性肠病、FAP、HNPCC 和随访 < 5 年。剩余的 421 例患者根据 5 年随访期间是否发生转移分为 TM+组（n = 75）和 TM-组（n = 346）。
TM+和 TM-组的 5 年生存率分别为 21%和 73%（p < 0.0001）。N0 与 N2、分级 2 与 3、UICC-I 与 -II 和 UICC-I 与 -III 之间的生存率差异有统计学意义（p < 0.05）。回归分析显示，诊断时年龄较大、N 分期增加、T 分期增加显著影响无复发生存率，而 N 分期和 T 分期增加是术后 5 年内发生转移的危险因素（HR 1.97 和 1.78；p < 0.0001）。
除了更高的 T 分期外，阳性 N 分期独立提示发生远处转移的可能性更高，并与生存不良相关。因此，我们的数据显示淋巴结切除术具有预后意义，应保留淋巴结切除术，直到有结论性研究表明淋巴结切除术不重要为止。
