Veen Torhild, Nedrebø Bjørn S, Stormark Kjartan, Søreide Jon Arne, Kørner Hartwig, Søreide Kjetil
Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
Dig Surg. 2013;30(1):1-11. doi: 10.1159/000349923. Epub 2013 Apr 10.
For patients undergoing curative resections for colon cancer, the nodal status represents the strongest prognostic factor, yet at the same time the most disputed issue as well. Consequently, the qualitative and quantitative aspects of lymph node evaluation are thus being scrutinized beyond the blunt distinction between 'node positive' (pN+) and 'node negative' (pN0) disease. Controversy ranges from a minimal or 'least-unit' strategy as exemplified by the 'sentinel node' to a maximally invasive or 'all inclusive' approach by extensive surgery. Ranging between these two extremes of node sampling strategies are factors of quantitative and qualitative value, which may be subject to modification. Qualitative issues may include aspects of lymph node harvest reflected by surgeon, pathologist and even hospital performance, which all may be subject to modification. However, patient's age, gender and genotype may be non-modifiable, yet influence node sample. Quantitative issues may reflect the balance between absolute numbers and models investigating the relationships of positive to negative nodes (lymph node ratio; log odds of positive lymph nodes). This review provides an updated overview of the current controversies and a state-of-the-art perspective on the qualitative and quantitative aspects of using lymph nodes as a prognostic marker in colon cancer.
对于接受结肠癌根治性切除术的患者，淋巴结状态是最强的预后因素，但同时也是最具争议的问题。因此，除了简单地区分“淋巴结阳性”（pN+）和“淋巴结阴性”（pN0）疾病外，淋巴结评估的定性和定量方面也在受到严格审查。争议范围从以“前哨淋巴结”为例的最小化或“最小单位”策略，到通过广泛手术的最大侵入性或“全部包含”方法。在这两种极端的淋巴结采样策略之间的是具有定量和定性价值的因素，这些因素可能会被修改。定性问题可能包括外科医生、病理学家甚至医院表现所反映的淋巴结采集方面，所有这些都可能会被修改。然而，患者的年龄、性别和基因型可能不可改变，但会影响淋巴结样本。定量问题可能反映绝对数量与研究阳性淋巴结与阴性淋巴结关系的模型（淋巴结比率；阳性淋巴结的对数优势）之间的平衡。本综述提供了当前争议的最新概述，以及关于在结肠癌中使用淋巴结作为预后标志物的定性和定量方面的最新观点。
