Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
PLoS One. 2013 Jul 16;8(7):e68526. doi: 10.1371/journal.pone.0068526. Print 2013.
Lymph node yield is recommended as a benchmark of quality care in colorectal cancer. The objective of this study was to evaluate the impact of various factors upon lymph node yield and to identify independent factors associated with lymph node harvest.
The records of 162 patients with Stage I to Stage III colorectal cancers seen in one institution were reviewed. These patients underwent radical surgery as definitive therapy; high-risk patients then received adjuvant treatment. Pathologic and demographic data were recorded and analyzed. The subgroup analysis of lymph node yields was determined using a t-test and analysis of variants. Linear regression model and multivariable analysis were used to perform potential confounding and predicting variables.
Five variables had significant association with lymph node yield after adjustment for other factors in a multiple linear regression model. These variables were: tumor size, surgical method, specimen length, and individual surgeon and pathologist. The model with these five significant variables interpreted 44.4% of the variation.
Patients, tumor characteristics and surgical variables all influence the number of lymph nodes retrieved. Physicians are the main gatekeepers. Adequate training and optimized guidelines could greatly improve the quality of lymph node yields.
淋巴结检出数目被推荐作为结直肠癌质量控制的基准。本研究的目的在于评估各种因素对淋巴结检出数目的影响，并确定与淋巴结获取相关的独立因素。
对 162 例在单家机构就诊的Ⅰ至Ⅲ期结直肠癌患者的记录进行了回顾性分析。这些患者接受了根治性手术作为确定性治疗；高危患者随后接受了辅助治疗。记录并分析了病理和人口统计学数据。采用 t 检验和方差分析对亚组的淋巴结检出量进行了分析。采用线性回归模型和多变量分析对潜在的混杂和预测变量进行了分析。
在对多个线性回归模型中的其他因素进行调整后，有 5 个变量与淋巴结检出量具有显著相关性。这些变量为：肿瘤大小、手术方法、标本长度以及术者和病理科医生的个体差异。包含这 5 个显著变量的模型可以解释 44.4%的变异。
患者、肿瘤特征和手术变量均会影响淋巴结检出数目。医生是主要的把关人。充分的培训和优化的指南可以极大地提高淋巴结检出的质量。
