Li Qingguo, Wang Changjian, Li Yaqi, Li Xinxiang, Xu Ye, Cai Guoxiang, Lian Peng, Cai Sanjun
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Oncotarget. 2017 Jul 18;8(29):48333-48342. doi: 10.18632/oncotarget.15696.
Lymph node (LN) status is one of the most important predictors for M0 colorectal cancer patients. However, its clinical impact on stage IV colorectal cancer remains unclear. The study aimed to explore the prognostic value of LN status after palliative resection of primary tumor for patients with metastatic colorectal cancer (mCRC). We combined analyses of mCRC patients in Surveillance, Epidemiology and End Results (SEER) database and Fudan University Shanghai Cancer Center (FUSCC).A total of 17,553 patients with mCRC were identified in SEER database. X-tile program was adopted to identify 2 and 10 as optimal cutoff values for negative lymph node (NLN) count to divide patients into 3 subgroups of high, middle and low risk of cancer related death. N stage and NLN count were verified as independent prognostic factors in multivariate analyses of patients in whole cohort and in subgroup analyses of each N stage (P<0.05). Validation of FUSCC cohort of patients demonstrated that metastatic tumor burden (P = 0.042), NLN count (P = 0.039) and sequential chemotherapy (P = 0.040) were significant predictors of poorer CSS. Specifically, the prognosis of patients at stage N0 was significantly more favorable than that of patients at stage N2 (P = 0.038). In conclusion, primary tumor LN status was a strong predictor of CSS after palliative resection of metastatic colorectal cancer. Advanced N stage and small number of NLN were correlated with high risk of cancer related death after palliative resection of primary tumor.
淋巴结（LN）状态是M0期结直肠癌患者最重要的预后指标之一。然而，其对IV期结直肠癌的临床影响仍不明确。本研究旨在探讨转移性结直肠癌（mCRC）患者原发肿瘤姑息性切除术后LN状态的预后价值。我们对监测、流行病学和最终结果（SEER）数据库以及复旦大学附属上海肿瘤医院（FUSCC）的mCRC患者进行了联合分析。
在SEER数据库中总共识别出17553例mCRC患者。采用X-tile程序确定阴性淋巴结（NLN）计数的最佳临界值为2和10，将患者分为癌症相关死亡高、中、低风险的3个亚组。在整个队列患者的多因素分析以及各N分期的亚组分析中，N分期和NLN计数均被证实为独立的预后因素（P<0.05）。FUSCC患者队列的验证表明，转移瘤负荷（P = 0.042）、NLN计数（P = 0.039）和序贯化疗（P = 0.040）是较差总生存（CSS）的显著预测因素。具体而言，N0期患者的预后明显优于N2期患者（P = 0.038）。总之，原发肿瘤LN状态是转移性结直肠癌姑息性切除术后CSS的有力预测指标。N分期进展和NLN数量少与原发肿瘤姑息性切除术后癌症相关死亡的高风险相关。
