Li Qingguo, Zhuo Changhua, Cai Guoxiang, Li Dawei, Liang Lei, Cai Sanjun
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China. Department of Surgical Oncology, Fujian Provincial Cancer Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, People's Republic of China.
Oncotarget. 2014 Dec 15;5(23):12459-71. doi: 10.18632/oncotarget.2560.
Preoperative radiation significantly decreases the number of retrieved lymph nodes (LNs) in rectal cancer, but little is known with respect to the prognostic significance of negative LN (NLN) counts under these circumstances. In this study, Surveillance, Epidemiology, and End Results Program (SEER)-registered ypIII stage rectal cancer patients, and patients from Fudan University Shanghai Cancer Center (FDSCC) were combined and analyzed. The results showed that the survival rate of patients with n (cutoff) or more NLNs increased gradually when n ranged from two to nine. After n reached 10 or greater, survival rates were approximately equivalent. Furthermore, the optimal cutoff value of 10 was validated as an independent prognostic factor in stage ypIIIB and ypIIIC patients by both univariate and multivariate analysis (P < 0.001); the number of NLNs could also stratify the prognosis of ypN(+) patients in more detail. Patients in the FDSCC set validated these findings and confirmed that NLN count was not decreased in the good tumor regression group relative to the poor tumor regression group. These results suggest that NLN count is an independent prognostic factor for ypIIIB and ypIIIC rectal cancer patients, and, together with the number of positive LNs, this will provide better prognostic information than the number of positive LNs alone.
术前放疗可显著减少直肠癌患者的淋巴结（LN）检出数量，但在这种情况下，关于阴性淋巴结（NLN）计数的预后意义却知之甚少。在本研究中，我们对监测、流行病学和最终结果计划（SEER）登记的ypIII期直肠癌患者以及复旦大学附属上海肿瘤医院（FDSCC）的患者进行了合并分析。结果显示，当NLN数量n从2增加到9时，NLN数量为n（临界值）及以上的患者生存率逐渐升高。当n达到10及以上时，生存率大致相当。此外，通过单因素和多因素分析均验证了临界值10作为ypIIIB期和ypIIIC期患者独立预后因素的有效性（P < 0.001）；NLN数量还可更详细地对ypN(+)患者的预后进行分层。FDSCC队列中的患者验证了这些发现，并证实相对于肿瘤退缩较差的组，肿瘤退缩良好组的NLN数量并未减少。这些结果表明，NLN数量是ypIIIB期和ypIIIC期直肠癌患者的独立预后因素，并且与阳性LN数量一起，比单独的阳性LN数量能提供更好的预后信息。
