Betge Johannes, Harbaum Lars, Pollheimer Marion J, Lindtner Richard A, Kornprat Peter, Ebert Matthias P, Langner Cord
Department of Medicine II, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Medicine II, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Int J Colorectal Dis. 2017 Jul;32(7):991-998. doi: 10.1007/s00384-017-2778-8. Epub 2017 Feb 16.
The study aimed to analyze clinicopathological factors that determine the extent of lymph node retrieval and to evaluate its prognostic impact in patients with colorectal cancer (CRC).
The number of retrieved lymph nodes was analyzed in 381 CRC specimens. Lymph node count was related to different clinicopathological variables by binary logistic regression. Progression-free survival (PFS) and cancer-specific survival (CSS) were determined using the Kaplan-Meier method and Cox regression models.
The median number of retrieved lymph nodes was 20 (mean 21 ± 10, range 1-65) in right-sided, 13 (16 ± 10, 1-66) in left-sided, and 15 (18 ± 11, 3-64) in rectal tumors. The number of retrieved lymph nodes was independently associated with T-classification (p < 0.001), N-classification (p = 0.014), and tumor size (p = 0.005) as well as right-sided tumor location (p = 0.012). There was no association with age, sex, tumor grade, mismatch-repair status, and lymph or blood vessel invasion. The longer the surgical specimen, the higher were the numbers of retrieved and positive lymph nodes (p < 0.001, respectively). In patients with locally advanced (T3/T4) tumors (n = 283), analysis of more than 12 lymph nodes was independently associated with PFS (HR = 0.63, p = 0.025) and CSS (HR = 0.54, p = 0.004). In the subset of T3/T4 N0 patients (n = 130), analysis of more than 12 lymph nodes similarly proved to be an independent predictor of outcome (PFS, HR = 0.48, p = 0.046; OS, HR = 0.41, p = 0.026).
The number of retrieved lymph nodes is associated with higher tumor stage, tumor size, and right-sided location. Low lymph node count indicates adverse outcome in patients with locally advanced (T3/T4) disease.
本研究旨在分析决定淋巴结清扫范围的临床病理因素，并评估其对结直肠癌（CRC）患者预后的影响。
对381例CRC标本的淋巴结清扫数量进行分析。通过二元逻辑回归分析淋巴结计数与不同临床病理变量的关系。采用Kaplan-Meier法和Cox回归模型确定无进展生存期（PFS）和癌症特异性生存期（CSS）。
右侧肿瘤标本的淋巴结清扫中位数为20个（均值21±10，范围1 - 65），左侧为13个（16±10，1 - 66），直肠肿瘤为15个（18±11，3 - 64）。淋巴结清扫数量与T分期（p < 0.001）、N分期（p = 0.014）、肿瘤大小（p = 0.005）以及右侧肿瘤位置（p = 0.012）独立相关。与年龄、性别、肿瘤分级、错配修复状态以及淋巴或血管侵犯无关。手术标本越长，清扫的淋巴结数量和阳性淋巴结数量越高（分别为p < 0.001）。在局部晚期（T3/T4）肿瘤患者（n = 283）中，清扫超过12个淋巴结与PFS（HR = 0.63，p = 0.025）和CSS（HR = 0.54，p = 0.004）独立相关。在T3/T4 N0患者亚组（n = 130）中，清扫超过12个淋巴结同样被证明是预后的独立预测因素（PFS，HR = 0.48，p = 0.046；OS，HR = 0.41，p = 0.026）。
清扫的淋巴结数量与更高的肿瘤分期、肿瘤大小及右侧位置相关。淋巴结计数低表明局部晚期（T3/T4）疾病患者预后不良。
