Sinan H, Demirbas S, Ersoz N, Ozerhan I H, Yagci G, Akyol M, Cetiner S
Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
Acta Chir Belg. 2012 May-Jun;112(3):200-8.
Many factors have been described influencing survival of patients with colorectal cancer. The most important prognostic factor is lymph node involvement. The National Comprehensive Cancer Network indicates that at least 12 lymph nodes (LN12) must be retrieved for proper staging and treatment planning. The surgeon and the pathologist influence the number of retrieved lymph nodes.
We retrospectively reviewed all patients with diagnosis and subsequent surgery for colorectal cancer from January 2004 to January 2010 at Gulhane Military Medical Academy in Ankara, Turkey. We investigated the relationship between LN 12 and the independent variables of tumour size, lymph node involvement, metastasis, age, gender, surgeon, pathologist, surgical specimen length, tumour stage, and localization. Statistical analysis utilized the Shapiro-Wilk test, interquartile range, Mann-Whitney test, chi-square and chi-square likelihood ratio tests, and Kruskal-Wallis nonparametric variance analysis. In order to identify influencing factors for retrieval of lymph nodes, multiple linear regression was performed. In order to identify the direction and extent of effects of these influencing factors, logistic regression was performed. OR (Odds Ratio) and 95% CI (Confidence Interval) of the OR were calculated.
There were 223 study patients, 134 with colon cancer and 89 with rectal cancer. There was no statistical significance in terms of age, gender, cancer type and postoperative tumour size, number of metastatic lymph nodes > 4, or LN12 (p > 0.05). Statistical significance was found between surgeons and LN12, the number of operations and LN12 (p < 0.001), and pathologists and LN12 (p = 0.049).
Harvesting an adequate number of lymph nodes is crucial for patients with colorectal cancer in terms of staging and planning further treatment modalities such as adjuvant chemotherapy. Multidisciplinary collaboration between surgeons and pathologists is vital for optimal patient outcomes.
已有诸多因素被描述为会影响结直肠癌患者的生存情况。最重要的预后因素是淋巴结受累情况。美国国立综合癌症网络指出，为了进行恰当的分期和治疗规划，必须获取至少12枚淋巴结（LN12）。外科医生和病理学家会影响获取的淋巴结数量。
我们回顾性分析了2004年1月至2010年1月在土耳其安卡拉的古尔汗军事医学院被诊断为结直肠癌并随后接受手术的所有患者。我们研究了LN12与肿瘤大小、淋巴结受累情况、转移情况、年龄、性别、外科医生、病理学家、手术标本长度、肿瘤分期及肿瘤定位这些独立变量之间的关系。统计分析采用了夏皮罗-威尔克检验、四分位距、曼-惠特尼检验、卡方检验和卡方似然比检验，以及克鲁斯卡尔-沃利斯非参数方差分析。为了确定影响淋巴结获取的因素，进行了多元线性回归分析。为了确定这些影响因素的作用方向和程度，进行了逻辑回归分析。计算了比值比（OR）及其95%置信区间（CI）。
共有223例研究患者，其中134例为结肠癌患者，89例为直肠癌患者。在年龄、性别、癌症类型、术后肿瘤大小、转移淋巴结数量>4或LN12方面，均无统计学意义（p>0.05）。在外科医生与LN12、手术次数与LN12之间发现有统计学意义（p<0.001），在病理学家与LN12之间也有统计学意义（p=0.049）。
对于结直肠癌患者而言，获取足够数量的淋巴结对于分期以及规划诸如辅助化疗等进一步的治疗方式至关重要。外科医生和病理学家之间的多学科协作对于实现最佳患者预后至关重要。
