Li Qingguo, Liang Lei, Jia Huixun, Li Xinxiang, Xu Ye, Zhu Ji, Cai Sanjun
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Oncotarget. 2016 Nov 1;7(44):72290-72299. doi: 10.18632/oncotarget.10806.
Negative lymph node counts has recently attracted attention as a prognostic indicator in colorectal cancer (CRC). But little is known about prognostic significance of negative to positive lymph node ratio (NPR) in CRC. Our aim was to determine impact of NPR on oncological outcomes in patients with stage III CRC. This retrospective study included 2,256 patients with stage III CRC under curative resection at Fudan university Shanghai cancer center. Kaplan-Meier methods and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors. Accuracy of the NPR was assessed with the Harrell's concordance-index(C-index).X-tile program identified 2.38 or 0.55/2.38 as the optimal cutoff value for NPR to divide the cohort into high/low risk or high/middle/low risk subsets in terms of CRC cause specific survival (CCSS). In a multivariate analysis, NPR was significant independent prognostic factors for CCSS (P<0.05), notably, N classification was not an independently prognostic factor (P>0.05).Further analysis found NPR could give detailed prognostic classification for both N1 and N2 stage (P<0.05). Interestingly, patients in N2+ NPR >2.38 stage have similar survival outcome with N1+ NPR >2.38 stage (χ2=0.030, P=0.863), and better than those at N1+ NPR ≤2.38 and N2+ NPR ≤2.38 stage (P<0.001). The TNNPRM stage was more accurate for predicting CCSS (C-index = 0.659) than current TNM stage system(C-index = 0.628) (P<0.001). Collectively, NPR was an independent prognostic factor for stage III CRC patients, it could provide more accurate prognostic information than the current node stage system.
阴性淋巴结计数最近作为结直肠癌（CRC）的一种预后指标受到关注。但关于CRC中阴性与阳性淋巴结比率（NPR）的预后意义知之甚少。我们的目的是确定NPR对III期CRC患者肿瘤学结局的影响。这项回顾性研究纳入了复旦大学附属肿瘤医院2256例接受根治性切除的III期CRC患者。采用Kaplan-Meier方法和多变量Cox回归模型分析生存结局和危险因素。用Harrell一致性指数（C指数）评估NPR的准确性。X-tile程序确定2.38或0.55/2.38为NPR的最佳截断值，以便根据CRC病因特异性生存（CCSS）将队列分为高/低风险或高/中/低风险亚组。在多变量分析中，NPR是CCSS的显著独立预后因素（P<0.05），值得注意的是，N分期不是独立的预后因素（P>0.05）。进一步分析发现NPR可为N1和N2期提供详细的预后分类（P<0.05）。有趣的是，N2 + NPR>2.38期患者的生存结局与N1 + NPR>2.38期患者相似（χ2 = 0.030，P = 0.863），且优于N1 + NPR≤2.38和N2 + NPR≤2.38期患者（P<0.001）。TNNPRM分期在预测CCSS方面（C指数 = 0.659）比目前的TNM分期系统（C指数 = 0.628）更准确（P<0.001）。总体而言，NPR是III期CRC患者的独立预后因素，它能比目前的淋巴结分期系统提供更准确的预后信息。
