Attaallah Wafi, Gunal Omer, Manukyan Manuk, Ozden Gulden, Yegen Cumhur
Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey.
Ann Coloproctol. 2013 Jun;29(3):100-5. doi: 10.3393/ac.2013.29.3.100. Epub 2013 Jun 30.
Lymph-node metastasis is the most important predictor of survival in stage III rectal cancer. The number of metastatic lymph nodes may vary depending on the level of specimen dissection and the total number of lymph nodes harvested. The aim of this study was to evaluate whether the lymph node ratio (LNR) is a prognostic parameter for patients with rectal cancer.
A retrospective review of a database of rectal cancer patients was performed to determine the effect of the LNR on the disease-free survival (DFS) and the overall survival. Of the total 228 patients with rectal cancer, 55 patients with stage III cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival.
According to the cutoff point 0.15 (15%), the 2-year DFS was 95.2% among patients with a LNR < 0.15 compared with 67.6% for those with LNR ≥ 0.15 (P = 0.02). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was independently associated with worse DFS.
This study showed the prognostic significance of ratio-based staging for rectal cancer and may help in developing better staging systems. LNR 0.15 (15%) was shown to be a cutoff point for determining survival and prognosis in rectal cancer cases.
淋巴结转移是Ⅲ期直肠癌生存的最重要预测指标。转移淋巴结的数量可能因标本解剖水平和所采集淋巴结的总数而异。本研究的目的是评估淋巴结比率（LNR）是否为直肠癌患者的一个预后参数。
对直肠癌患者数据库进行回顾性分析，以确定LNR对无病生存期（DFS）和总生存期的影响。在总共228例直肠癌患者中，55例Ⅲ期癌症患者符合分析条件。采用Kaplan-Meier法估计生存曲线。在对潜在混杂因素进行调整后，使用Cox回归分析来评估LNR与生存之间的关系。
根据截断点0.15（15%），LNR<0.15的患者2年DFS为95.2%，而LNR≥0.15的患者为67.6%（P=0.02）。在对年龄、性别、组织学和肿瘤状态进行调整的分层和多变量分析中，较高的LNR与较差的DFS独立相关。
本研究显示了基于比率分期对直肠癌的预后意义，并可能有助于开发更好的分期系统。LNR 0.15（15%）被证明是确定直肠癌病例生存和预后的一个截断点。
