病理医生的敬业精神对结直肠癌淋巴结检出率和术后生存的影响。

Effect of pathologist's dedication on lymph node detection rate and postoperative survival in colorectal cancer.

机构信息

Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.

Department of Pathology, Clinical, Institute of Pathology, Medical University of Vienna, Vienna, Austria.

出版信息

Colorectal Dis. 2018 Jul;20(7):O173-O180. doi: 10.1111/codi.14241. Epub 2018 May 14.

DOI:10.1111/codi.14241

PMID:29706021

Abstract

AIM

As adjuvant chemotherapy in colorectal cancer relies on the identification of lymph node metastases, the pathologist's dedication may have a considerable influence on postoperative survival.

METHOD

The aim of this retrospective study was to assess the impact of the pathologist's dedication on lymph node detection rate and postoperative survival in patients operated on by a single experienced colorectal surgeon within a 5-year period. We assessed 229 patients undergoing total mesorectal excision or complete mesocolic excision by the senior author between 1 January 2009 and 31 December 2013. Pathologists were grouped as 'general pathologist' or 'dedicated pathologist' depending on their dedication/specialization.

RESULTS

Dedicated pathologists found statistically significantly more lymph nodes in colorectal specimens than general pathologists [23 (interquartile range 24) vs 14 (interquartile range 11), respectively; P < 0.001]. The detection rate of ≥ 12 lymph nodes per specimen was significantly higher in the dedicated pathologist group [65/74 (87.8%) vs 105/155 (67.7%); P = 0.016]. However, postoperative survival did not differ in the respective subgroups. In the multivariable analysis by Cox proportional hazard model, International Union against Cancer Stage IV was the only factor associated with decreased disease-specific survival (hazard ratio 28.257; 95% CI 3.850-207.386; P = 0.001).

CONCLUSION

In our centre, the pathologist's dedication has an impact on lymph node detection rate but does not influence postoperative disease-specific survival.

摘要

目的

由于结直肠癌的辅助化疗依赖于淋巴结转移的识别，因此病理学家的专注程度可能对术后生存有相当大的影响。

方法

本回顾性研究旨在评估在 5 年内由一位经验丰富的结直肠外科医生进行手术的患者中，病理学家的专注程度对淋巴结检出率和术后生存的影响。我们评估了 2009 年 1 月 1 日至 2013 年 12 月 31 日期间由资深作者进行的全直肠系膜切除术或完整结肠系膜切除术的 229 例患者。病理学家根据其专注程度/专业知识分为“普通病理学家”或“专门病理学家”。

结果

专门的病理学家在结直肠标本中发现的淋巴结数量明显多于普通病理学家[分别为 23（四分位间距 24）与 14（四分位间距 11）；P<0.001]。专门病理学家组中，每个标本检出≥12 个淋巴结的检出率显著更高[65/74（87.8%）比 105/155（67.7%）；P=0.016]。然而，各组术后生存无差异。在 Cox 比例风险模型的多变量分析中，国际抗癌联盟（UICC）分期 IV 期是唯一与疾病特异性生存降低相关的因素（风险比 28.257；95%CI 3.850-207.386；P=0.001）。