Li Xinxing, Lu Hao, Xu Kai, Wang Haolu, Liang Xiaowen, Hu Zhiqian
Department of General Surgery, Changzheng Hospital, The Second Military Medical University, 415 S. Fengyang Road, Shanghai, 200003, China.
Therapeutics Research Centre, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia.
BMC Cancer. 2017 Mar 28;17(1):227. doi: 10.1186/s12885-017-3222-8.
Negative lymph node (NLN) count has been reported to provide more accurate prognostic information than the N stage alone in patients with rectal cancer (RC). Since preoperative radiotherapy (Pre-RT) can significantly affect the LN status, it is unclear whether NLN count still has prognostic value count on survival of patients with RC who received Pre-RT.
In this study, clinicopathological characteristics, number of positive LNs and survival time were collected from Surveillance, Epidemiology, and End Results Program (SEER)-registered RC patients. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors for survival.
X-tile plots identified 9 (P < 0.001) as the optimal cutoff NLN value to divide the patients into high and low risk subsets in terms of cause specific survival (CSS). NLN count was validated as independently prognostic factor in univariate and multivariate analysis (P < 0.001). Subgroup analysis showed that NLN count was an independently prognostic factor for patients with stage ypII (P = 0.002) and ypIII (P < 0.001).
Our results firmly demonstrated that NLN count provides accurate prognostic information for RC patients with Pre-RT.
据报道，在直肠癌（RC）患者中，阴性淋巴结（NLN）计数比单独的N分期能提供更准确的预后信息。由于术前放疗（Pre-RT）会显著影响淋巴结状态，目前尚不清楚NLN计数对于接受Pre-RT的RC患者的生存是否仍具有预后价值。
在本研究中，收集了监测、流行病学和最终结果计划（SEER）登记的RC患者的临床病理特征、阳性淋巴结数量和生存时间。采用单因素和多因素Cox比例风险模型评估生存的危险因素。
X-tile图确定9（P < 0.001）为最佳截断NLN值，以便根据特定病因生存率（CSS）将患者分为高风险和低风险亚组。在单因素和多因素分析中，NLN计数被确认为独立的预后因素（P < 0.001）。亚组分析表明，NLN计数是ypII期（P = 0.002）和ypIII期（P < 0.001）患者的独立预后因素。
我们的结果有力地证明，NLN计数为接受Pre-RT的RC患者提供了准确的预后信息。
