我们是否达到了结直肠癌标本中获取12个淋巴结的基准？来自印度一家三级转诊中心的经验及文献综述。

Are we achieving the benchmark of retrieving 12 lymph nodes in colorectal carcinoma specimens? Experience from a tertiary referral center in India and review of literature.

作者信息

Deodhar Kedar K, Budukh Atul, Ramadwar Mukta, Bal Munita Meenu, Shrikhande S V

机构信息

Department of Pathology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai, India.

出版信息

Indian J Pathol Microbiol. 2012 Jan-Mar;55(1):38-42. doi: 10.4103/0377-4929.94853.

DOI:10.4103/0377-4929.94853

PMID:22499298

Abstract

INTRODUCTION

The number of lymph nodes (LNs) retrieved from a specimen of colorectal carcinoma may vary. Factors that can possibly affect LN yield are age of the patient, obesity, location of the tumor, neoadjuvant therapy, surgical technique and pathologist's handling of the specimen.

AIM

The aim of our study is to look at lymph node retrieval from colorectal cancer (CRC) specimens in our hands and review the literature.

MATERIALS AND METHODS

From May 2010 to January 2011, a total of 170 colorectal carcinoma cases were operated in our institute. Type of the surgeries, lymph node yield was looked at.

RESULTS

There were 103 (60.6%) males and 67 (39.4%) females. The commonest age group was 50-59 years (30.6%). The surgeries included 107 surgeries for rectal carcinoma (63%) and 63 surgeries for colonic carcinoma (37%). Sixty six (38.8%) cases had received preoperative chemoradiotherapy, whereas 104 (61.2%) cases were without adjuvant therapy. The total lymph node positivity (metastatic disease) was 44.7% .The overall mean lymph node yield was 12.68 (range 0-63; median 11). The mean lymph node harvest in the age group < 39 was 15.76 whereas, the lymph node harvest in the group more than 39 years old was 11.90. ( statistically significant; P=0.03). The mean lymph node yield from specimens of rectal cancers (10.30) was lower than the mean lymph node yield from specimens for colonic cancers (16.71);( statistically significant, P<0.01). There was also statistically significant difference between the mean LN yield in chemoradionaiive cases (14.63) and in the cases where neoadjuvant therapy was received, (9.59); P<0.01.

CONCLUSION

Pathologist while assessing a specimen of CRC should aim to retrieve a minimum of 12 LN. Surgical expertise and diligence of the pathologists remain two main alterable factors that can improve this yield. Neoadjuvant or preoperative radiotherapy can yield in less number of nodes.

摘要

引言

从结直肠癌标本中获取的淋巴结数量可能会有所不同。可能影响淋巴结获取量的因素包括患者年龄、肥胖、肿瘤位置、新辅助治疗、手术技术以及病理学家对标本的处理。

目的

我们研究的目的是观察我们手中结直肠癌（CRC）标本的淋巴结获取情况并回顾相关文献。

材料与方法

2010年5月至2011年1月，我院共对170例结直肠癌病例进行了手术。观察手术类型及淋巴结获取量。

结果

男性103例（60.6%），女性67例（39.4%）。最常见的年龄组为50 - 59岁（30.6%）。手术包括107例直肠癌手术（63%）和63例结肠癌手术（37%）。66例（38.8%）病例接受了术前放化疗，而104例（61.2%）病例未接受辅助治疗。总的淋巴结阳性率（转移性疾病）为44.7%。总体平均淋巴结获取量为12.68（范围0 - 63；中位数11）。年龄小于39岁组的平均淋巴结获取量为15.76，而39岁以上组的淋巴结获取量为11.90。（具有统计学意义；P = 0.03）。直肠癌标本的平均淋巴结获取量（10.30）低于结肠癌标本的平均淋巴结获取量（16.71）；（具有统计学意义，P < 0.01）。接受放化疗病例的平均淋巴结获取量（14.63）与接受新辅助治疗病例的平均淋巴结获取量（9.59）之间也存在统计学显著差异；P < 0.01。