Jiang Chang, Wang Fang, Guo Guifang, Dong Jun, Liu Shousheng, He Wenzhuo, Zhang Bei, Xia Liangping
VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China.
State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, 510060, R.P. China.
J Cancer. 2019 Jun 2;10(11):2534-2540. doi: 10.7150/jca.29216. eCollection 2019.
: It has been shown that the metastatic lymph node ratio (LNR, metastatic LNs divided by the total number of retrieved LNs) significantly affects the prognosis of patients with non-stage IV and some curative stage IV colon cancer undergoing curative resection. In this study, we aimed to evaluate the role of the LNR as a predictor of prognosis in patients with stage IV colon cancer undergoing curative or palliative resection. : We conducted a retrospective study of 424 patients who were initially diagnosed with stage IV colon cancer at the Sun Yat-Sen University Cancer Center from 2003 to 2014. The patients were divided into the curative and palliative primary tumor resection groups with regional lymph nodes harvest. The median value was used as the cutoff for the LNR. Overall survival (OS) was assessed with the Kaplan-Meier method and log-rank test. Multivariate analysis was performed to identify the prognostic factors for OS. : The cutoff value for the LNR was 0.2. A total of 71 and 353 patients were classified as being in the curative and palliative resection groups, respectively. Patients in the palliative resection group showed higher pretreatment levels of carbohydrate antigen 19-9 (CA199; = 0.014), a deeper infiltration of the primary tumor ( = 0.049), a lower regional lymph node harvest (i.e., total lymph node yield [TLN] ≤ 11; = 0.001), and more extensive metastasis ( = 0.006). Among all patients, initial elevated CA199 levels, a TLN≤11, a negative lymph nodes (NLN) ≤7, and a LNR ≤0.2 were significantly associated with an unfavorable prognosis. OS was significantly longer in patients with a low LNR in both groups ( = 0.008 and = 0.001, respectively). The LNR was an independent prognostic indicator in patients with stage IV colon cancer, with a hazard ratio (HR) of 1.47 (95% confidence interval [CI] 1.14-1.91; = 0.003) in total population, and an HR of 1.43 (95% CI 1.09-1.86; = 0.009) in patients with palliative resection. : The LNR can be used as an independent prognostic factor in patients with stage IV colon cancer patients undergoing resection.
研究表明，转移淋巴结比率（LNR，即转移淋巴结数除以获取的淋巴结总数）对接受根治性切除的非IV期及部分可治愈的IV期结肠癌患者的预后有显著影响。在本研究中，我们旨在评估LNR作为接受根治性或姑息性切除的IV期结肠癌患者预后预测指标的作用。
我们对2003年至2014年在中山大学肿瘤防治中心初诊为IV期结肠癌的424例患者进行了一项回顾性研究。患者被分为行根治性和姑息性原发肿瘤切除并清扫区域淋巴结的组。以中位数作为LNR的截断值。采用Kaplan-Meier法和对数秩检验评估总生存期（OS）。进行多因素分析以确定OS的预后因素。
LNR的截断值为0.2。分别有71例和353例患者被归类为根治性切除组和姑息性切除组。姑息性切除组患者术前糖类抗原19-9（CA199）水平较高（P = 0.014），原发肿瘤浸润更深（P = 0.049），区域淋巴结清扫较少（即总淋巴结收获量[TLN]≤11；P = 0.001），转移更广泛（P = 0.006）。在所有患者中，初始CA199水平升高、TLN≤11、阴性淋巴结（NLN）≤7以及LNR≤0.2均与不良预后显著相关。两组中LNR低的患者OS均显著更长（分别为P = 0.008和P = 0.001）。LNR是IV期结肠癌患者的独立预后指标，在总人群中的风险比（HR）为1.47（95%置信区间[CI] 1.14 - 1.91；P = 0.003），在姑息性切除患者中的HR为1.43（95% CI 1.09 - 1.86；P = 0.009）。
LNR可作为接受切除的IV期结肠癌患者的独立预后因素。
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