结直肠癌的淋巴结清扫质量评估标准是否可以外推至直肠癌？
Should quality measures for lymph node dissection in colon cancer be extrapolated to rectal cancer?
机构信息
Department of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
出版信息
Am J Surg. 2012 Dec;204(6):843-7; discussion 847-8. doi: 10.1016/j.amjsurg.2012.05.003. Epub 2012 Sep 13.
BACKGROUND
A minimum of 12 lymph nodes has been endorsed as a quality measure to confirm node-negative colon cancer, but its relevance to early-stage rectal cancer is unclear.
METHODS
Patients with stage I or II rectal cancer from the Surveillance, Epidemiology and End Results tumor registries from 1998 to 2002 were identified. Patients were grouped by the number of lymph nodes sampled. Groups were compared for patient demographics, tumor characteristics, and 5-year overall survival.
RESULTS
Of the 6,214 patients (57% men) identified, only 33% had ≥12 lymph nodes examined in the surgical specimen. Multivariate analysis identified sex, race, age, T stage, and number of lymph nodes examined as independent predictors of 5-year overall survival.
CONCLUSIONS
Five-year overall survival improved as the number of sampled nodes increased. A thorough lymphadenectomy should routinely be performed to optimize staging and to improve survival of patients with early-stage rectal cancer.
背景
为了确认结肠癌的淋巴结阴性状态，至少需要检查 12 个淋巴结，这已被认可为一项质量标准，但该标准对早期直肠癌的相关性尚不清楚。
方法
从 1998 年至 2002 年的监测、流行病学和最终结果肿瘤登记处中确定了 I 期或 II 期直肠癌患者。根据取样的淋巴结数量对患者进行分组。比较了各组的患者人口统计学特征、肿瘤特征和 5 年总生存率。
结果
在确定的 6214 名患者（57%为男性）中，只有 33%的患者在手术标本中检查了≥12 个淋巴结。多变量分析确定了性别、种族、年龄、T 分期和检查的淋巴结数量是 5 年总生存率的独立预测因素。
结论
随着取样淋巴结数量的增加，5 年总生存率提高。应常规进行彻底的淋巴结清扫术，以优化分期并提高早期直肠癌患者的生存率。
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