Department of Surgery, University of Alexandria, El Raml Station, Alexandria 21321, Egypt.
Department of Surgery, University of Alexandria, El Raml Station, Alexandria 21321, Egypt.
Am J Surg. 2014 Jun;207(6):824-31. doi: 10.1016/j.amjsurg.2013.07.022. Epub 2013 Oct 8.
The aim of this study was to assess the prognostic value of metastatic lymph node (LN) ratio (MLNR) in stage III rectal cancer and whether this prognostic value remains significant when <12 LNs are retrieved.
This prospective study included 115 patients with stage III rectal cancer from 2006 to 2010. All patients underwent neoadjuvant long-course chemoradiation, curative resection, and postoperative adjuvant therapy (5-fluorouracil and leucovorin). Data collected included demographics, tumor pathology, tumor-node-metastasis staging, number of LNs retrieved, MLNR, recurrence, and mortality.
The mean number of examined LNs was 12.1, and the mean number of metastatic LNs was 3.5 (range, 1 to 19). The mean MLNR was .37 (range, 0 to 1.00). The mean duration of follow-up was 37 months (range, 24 to 63). Forty patients died during the follow-up period (overall mortality, 34.8%), only 31 because of cancer (cancer-specific mortality, 27%). Univariate analysis revealed that ypN stage, lymphovascular invasion, and follow-up duration were significantly associated with increased recurrence and decreased survival. Number of positive nodes and ypT stage significantly affected recurrence, with no effect on overall survival. Multivariate analysis proved that MLNR was the only independent risk factor for both mortality and recurrence. Prognostic capability was not affected by having <12 nodes retrieved. The best sensitivity and specificity of MLNR as a prognostic factor for both tumor recurrence and overall survival were achieved at a cutoff value of .375.
MLNR is an independent prognostic factor for recurrence and survival after the resection of stage III rectal cancer, with high sensitivity and specificity in patients who received neoadjuvant chemoradiation and postoperative chemotherapy. The total number of LN retrieved did not affect the prognostic value of MLNR even if <12.
本研究旨在评估 III 期直肠癌中转移性淋巴结（MLNR）的预后价值，以及在淋巴结检出数<12 时，该预后价值是否仍然显著。
本前瞻性研究纳入了 2006 年至 2010 年间的 115 例 III 期直肠癌患者。所有患者均接受了新辅助长程放化疗、根治性切除和术后辅助治疗（5-氟尿嘧啶和亚叶酸）。收集的数据包括人口统计学、肿瘤病理学、肿瘤-淋巴结-转移分期、检出的淋巴结数量、MLNR、复发和死亡。
平均检查的淋巴结数量为 12.1 个，平均转移性淋巴结数量为 3.5 个（范围为 1 至 19 个）。平均 MLNR 为 0.37（范围为 0 至 1.00）。平均随访时间为 37 个月（范围为 24 至 63 个月）。40 例患者在随访期间死亡（总死亡率为 34.8%，仅 31 例死于癌症[癌症特异性死亡率为 27%]）。单因素分析显示，ypN 分期、淋巴血管侵犯和随访时间与复发增加和生存时间缩短显著相关。阳性淋巴结数量和 ypT 分期显著影响复发，但对总生存无影响。多因素分析证实，MLNR 是死亡率和复发的唯一独立危险因素。即使淋巴结检出数<12，MLNR 作为预后因素的预测能力也不受影响。当 MLNR 截断值为 0.375 时，作为肿瘤复发和总生存的预后因素，其具有最佳的敏感性和特异性。
在接受新辅助放化疗和术后化疗的患者中，MLNR 是 III 期直肠癌切除术后复发和生存的独立预后因素，具有较高的敏感性和特异性。即使淋巴结检出数<12，总淋巴结检出数也不会影响 MLNR 的预后价值。
