Orsenigo Elena, Gasparini Giulia, Carlucci Michele
Department of General and Emergency Surgery, San Raffaele Scientific Institute, 20132 Milan, Italy.
Vita-Salute San Raffaele University, 20132 Milan, Italy.
Gastroenterol Res Pract. 2019 Jan 22;2019:5197914. doi: 10.1155/2019/5197914. eCollection 2019.
Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08 ± 11.4, 20.34 ± 11.8, and 15.33 ± 9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes ( = 0.002, log-rank test). Rectal cancer patients with 12 or more lymph nodes removed approached but did not reach a statistically different survival ( = 0.055, log-rank test). Multiple tumor and patients' factors are associated with lymph node yield, but only the removal of at least 12 lymph nodes will reliably determine lymph node status.
许多结直肠癌切除术所获取的淋巴结数量未达到美国癌症联合委员会推荐的用于准确分期结直肠癌所需的至少12枚淋巴结标准。本研究旨在调查影响接受常规病理评估的结直肠标本中足够淋巴结获取数量的因素。我们回顾性分析了1993年至2017年期间米兰圣拉斐尔科学研究所2319例接受根治性切除的结直肠癌患者的数据（1259例结肠癌患者、675例直肠癌患者以及385例接受新辅助治疗的直肠癌患者）。对影响淋巴结获取的因素进行单因素和多因素分析。此外，进行生存分析以验证淋巴结计数的预后意义。在接受手术治疗的右侧结肠癌、左侧结肠癌和直肠肿瘤患者中，评估淋巴结的平均数量分别为24.08±11.4、20.34±11.8和15.33±9.64。在结肠癌队列中，1094例（86.9%）手术标本报告有超过12枚淋巴结，在直肠癌队列中，425例（63%）有超过12枚淋巴结，对接受新辅助放化疗的患者进行单独分析。在结肠癌组的单因素分析中，较高的淋巴结计数与女性、右半结肠癌、急诊手术、pT3 - T4期疾病、较大肿瘤大小和切除标本长度相关。多因素分析发现，右半结肠肿瘤、较大的肿瘤平均大小、标本长度、pT3 - T4期疾病和女性性别显著影响淋巴结获取。切除12枚或更多淋巴结的结肠癌患者的长期生存率明显优于切除11枚或更少淋巴结的患者（对数秩检验，P = 0.002）。切除12枚或更多淋巴结的直肠癌患者的生存率接近但未达到统计学差异（对数秩检验，P = 0.055）。多种肿瘤和患者因素与淋巴结获取数量相关，但只有切除至少12枚淋巴结才能可靠地确定淋巴结状态。
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