Vergara-Fernandez Omar, Navarro-Navarro Adolfo, Rangel-Ríos Hugo Antonio, Salgado-Nesme Noel, Reyes-Monroy José Aristeo, Velázquez-Fernández David
Department of Colon and Rectal Surgery. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Endocrine Surgery. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Rev Invest Clin. 2018;70(6):291-300. doi: 10.24875/RIC.18002505.
In colorectal cancer (CRC), regional lymphadenectomy provides prognostic information and guides management. The current consensus states that at least 12 lymph nodes (LN) should be evaluated. The aims of this study were to identify whether the number of LN is a predictor for survival and recurrence, and to reveal the role of LN ratio (LNR) and perineural invasion (PNI) in predicting prognosis after curative resection of CRC.
We included all patients who underwent surgery for CRC between 2000 and 2016 in an academic medical center in Mexico. The LNR cutoff value was 0.25. We analyzed two groups according to the number of LN retrieved: Group 1 (≥ 12 LN) and Group 2 (< 12 LN).
We included 305 patients, 13.8% in Stage I, 45.6% in Stage II, and 40.6% in Stage III. The male: female ratio was 1.1. The mean age was 62.6 ± 14 years (range, 19-92). In 233 patients (76.4%), ≥ 12 LN were obtained. Recurrence rates in Groups 1 and 2 were 20.2% versus 26.4%, respectively (p = 0.16). PNI was present in 34 patients (13.2%). An LN harvest < 10 increased local and distant recurrences (p = 0.03). Stage III patients with an LNR ≥ 0.25 had higher overall recurrence rates (p = 0.012) and mortality (p = 0.029). In a multivariate Cox regression analysis, PNI-negative tumors were an independent prognostic factor for disease-free survival (p = 0.011, hazard ratio = 2.78, 95% confidence interval = 1.26-6.16).
An LN retrieval < 10 increased local and distant recurrence rates. LNR was an independent prognostic factor for survival in Stage III tumors. PNI was the only significant independent prognostic factor affecting disease-free survival in our patients.
在结直肠癌（CRC）中，区域淋巴结清扫可提供预后信息并指导治疗。目前的共识是至少应评估12枚淋巴结（LN）。本研究的目的是确定淋巴结数量是否为生存和复发的预测指标，并揭示淋巴结比率（LNR）和神经周围侵犯（PNI）在CRC根治性切除术后预测预后中的作用。
我们纳入了2000年至2016年间在墨西哥一家学术医学中心接受CRC手术的所有患者。LNR临界值为0.25。我们根据获取的淋巴结数量分析两组：第1组（≥12枚LN）和第2组（<12枚LN）。
我们纳入了305例患者，I期占13.8%，II期占45.6%，III期占40.6%。男女比例为1.1。平均年龄为62.6±14岁（范围19 - 92岁）。233例患者（76.4%）获取的LN≥12枚。第1组和第2组的复发率分别为20.2%和26.4%（p = 0.16）。34例患者（13.2%）存在PNI。获取的LN<10枚会增加局部和远处复发率（p = 0.03）。LNR≥0.25的III期患者总体复发率更高（p = 0.012），死亡率更高（p = 0.029）。在多因素Cox回归分析中，PNI阴性肿瘤是无病生存的独立预后因素（p = 0.011，风险比 = 2.78，95%置信区间 = 1.26 - 6.16）。
获取的LN<10枚会增加局部和远处复发率。LNR是III期肿瘤生存的独立预后因素。PNI是影响我们患者无病生存的唯一重要独立预后因素。
