Zeng Wei-Gen, Zhou Zhi-Xiang, Wang Zheng, Liang Jian-Wei, Hou Hui-Rong, Zhou Hai-Tao, Zhang Xing-Mao, Hu Jun-Jie
Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China E-mail :
Asian Pac J Cancer Prev. 2014;15(13):5365-9. doi: 10.7314/apjcp.2014.15.13.5365.
The lymph node ratio (LNR) has been shown to be an important prognostic factor for colorectal cancer. However, studies focusing on the prognostic impact of LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) followed by curative resection have been limited. The aim of this study was to investigate LNR in rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) followed by curative resection.
A total of 131 consecutive rectal cancer patients who underwent neoadjuvant CRT and total mesorectal excision were included in this study. Patients were divided into two groups according to the LNR (≤ 0.2 [n=86], >0.2 [n=45]) to evaluate the prognostic effect on overall survival (OS) and disease-free survival (DFS).
The median number of retrieved and metastatic lymph node (LN) was 14 (range 1-48) and 2 (range 1-10), respectively. The median LNR was 0.154 (range 0.04-1.0). In multivariate analysis, LNR was shown to be an independent prognostic factor for both overall survival (hazard ratio[HR]= 3.778; 95% confidence interval [CI] 1.741-8.198; p=0.001) and disease-free survival (HR=3.637; 95%CI 1.838- 7.195; p<0.001). Increased LNR was significantly associated with worse OS and DFS in patients with <12 harvested LNs, and as well as in those ≥ 12 harvested LNs (p<0.05). In addition, LNR had a prognostic impact on both OS and DFS in patients with N1 staging (p<0.001).
LNR is an independent prognostic factor in ypN-positive rectal cancer patients, both in patients with <12 harvested LNs, and as well as in those ≥ 12 harvested LNs. LNR provides better prognostic value than pN staging. Therefore, it should be used as an additional prognostic indicator in ypN-positive rectal cancer patients.
淋巴结比率（LNR）已被证明是结直肠癌的一个重要预后因素。然而，针对接受新辅助放化疗（CRT）后行根治性切除术的直肠癌患者中LNR的预后影响的研究有限。本研究的目的是调查接受新辅助放化疗（CRT）后行根治性切除术的直肠癌患者的LNR。
本研究共纳入131例连续接受新辅助CRT和全直肠系膜切除术的直肠癌患者。根据LNR将患者分为两组（≤0.2 [n = 86]，>0.2 [n = 45]），以评估对总生存期（OS）和无病生存期（DFS）的预后影响。
回收的和转移的淋巴结（LN）中位数分别为14个（范围1 - 48个）和2个（范围1 - 10个）。LNR中位数为0.154（范围0.04 - 1.0）。在多变量分析中，LNR被证明是总生存期（风险比[HR]= 3.778；95%置信区间[CI] 1.741 - 8.198；p = 0.001）和无病生存期（HR = 3.637；95%CI 1.838 - 7.195；p < 0.001）的独立预后因素。LNR升高与回收淋巴结数<12个的患者以及回收淋巴结数≥12个的患者的OS和DFS较差显著相关（p < 0.05）。此外，LNR对N1分期患者的OS和DFS均有预后影响（p < 0.001）。
LNR是ypN阳性直肠癌患者的独立预后因素，无论回收淋巴结数<12个的患者还是回收淋巴结数≥12个的患者。LNR比pN分期具有更好的预后价值。因此，它应用作ypN阳性直肠癌患者的额外预后指标。
