结直肠癌切除术中淋巴结计数的预测因素：来自美国全国前瞻性队列研究的数据。
Predictors of lymph node count in colorectal cancer resections: data from US nationwide prospective cohort studies.
作者信息
Morikawa Teppei, Tanaka Noriko, Kuchiba Aya, Nosho Katsuhiko, Yamauchi Mai, Hornick Jason L, Swanson Richard S, Chan Andrew T, Meyerhardt Jeffrey A, Huttenhower Curtis, Schrag Deborah, Fuchs Charles S, Ogino Shuji
机构信息
Department of Medical Oncology, Dana-Farber Cancer Institute and Havard Medical School, Boston, MA 02215, USA.
出版信息
Arch Surg. 2012 Aug;147(8):715-23. doi: 10.1001/archsurg.2012.353.
OBJECTIVE
To identify factors that influence the total and negative lymph node counts in colorectal cancer resection specimens independent of pathologists and surgeons.
DESIGN
We used multivariate negative binomial regression. Covariates included age, sex, body mass index, family history of colorectal carcinoma, year of diagnosis, hospital setting, tumor location, resected colorectal length (specimen length), tumor size, circumferential growth, TNM stage, lymphocytic reactions and other pathological features, and tumor molecular features (microsatellite instability, CpG island methylator phenotype, long interspersed nucleotide element 1 [LINE-1] methylation, and BRAF, KRAS, and PIK3CA mutations).
SETTING
Two US nationwide prospective cohort studies.
PATIENTS
Patients with rectal and colon cancer (N=918).
MAIN OUTCOME MEASURES
The negative and total node counts (continuous).
RESULTS
Specimen length, tumor size, ascending colon location, T3N0M0 stage, and year of diagnosis were positively associated with the negative node count (all P.002). Mutation of KRAS might also be positively associated with the negative node count (P=.03; borderline significance considering multiple hypothesis testing). Among node-negative (stages I and II) cases, specimen length, tumor size, and ascending colon location remained significantly associated with the node count (all P.002), and PIK3CA and KRAS mutations might also be positively associated (P=.03 and P=.049, respectively, with borderline significance).
CONCLUSIONS
This molecular pathological epidemiology study shows that specimen length, tumor size, tumor location, TNM stage, and year of diagnosis are operator-independent predictors of the lymph node count. These crucial variables should be examined in any future evaluation of the adequacy of lymph node harvest and nodal staging when devising individualized treatment plans for patients with colorectal cancer.
目的
确定在不考虑病理学家和外科医生因素的情况下，影响结直肠癌切除标本中淋巴结总数和阴性淋巴结数的因素。
设计
我们使用了多变量负二项回归。协变量包括年龄、性别、体重指数、结直肠癌家族史、诊断年份、医院环境、肿瘤位置、切除的结直肠长度（标本长度）、肿瘤大小、环周生长、TNM分期、淋巴细胞反应及其他病理特征，以及肿瘤分子特征（微卫星不稳定性、CpG岛甲基化表型、长散在核元件1 [LINE-1]甲基化，以及BRAF、KRAS和PIK3CA突变）。
研究背景
两项美国全国性前瞻性队列研究。
患者
直肠癌和结肠癌患者（N = 918）。
主要观察指标
阴性和阳性淋巴结数（连续变量）。
结果
标本长度、肿瘤大小、升结肠位置、T3N0M0分期和诊断年份与阴性淋巴结数呈正相关（均P < 0.002）。KRAS突变可能也与阴性淋巴结数呈正相关（P = 0.03；考虑多重假设检验时为临界显著性）。在淋巴结阴性（I期和II期）病例中，标本长度、肿瘤大小和升结肠位置仍与淋巴结数显著相关（均P < 0.002），PIK3CA和KRAS突变可能也呈正相关（分别为P = 0.03和P = 0.049，均为临界显著性）。
结论
这项分子病理流行病学研究表明，标本长度、肿瘤大小、肿瘤位置、TNM分期和诊断年份是与操作者无关的淋巴结数预测因素。在为结直肠癌患者制定个体化治疗方案时，在未来任何对淋巴结清扫充分性和淋巴结分期的评估中，都应检查这些关键变量。
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