Surgical Health Outcomes Consortium, Center for Colon and Rectal Surgery, AdventHealth Orlando, Orlando, FL; Department of Surgery, McGill University Health Centre, Montreal, QC.
Surgical Health Outcomes Consortium, Center for Colon and Rectal Surgery, AdventHealth Orlando, Orlando, FL.
Surgery. 2019 Oct;166(4):639-647. doi: 10.1016/j.surg.2019.03.027. Epub 2019 Aug 7.
Current standards for lymph node harvest in colorectal cancer surgery may be inadequate. Higher lymph node yield may improve survival, but the number of lymph nodes needed to optimize survival is unknown. The objective of this study was to examine the relationship between lymph node yield and overall survival in patients undergoing colectomy for nonmetastatic colon adenocarcinoma.
The 2010 to 2014 National Cancer Database was queried for patients undergoing colectomy for nonmetastatic colon adenocarcinoma. Adjusted restricted cubic splines were used to model the nonlinear relationship between lymph node harvest and overall survival. Cox proportional hazard determined independent predictors of overall survival.
A total of 261,423 patients were included. Restricted cubic splines demonstrated that the adjusted improvements in overall survival stabilized after 24 nodes. Patients were divided into: <12, 12 to 23, and ≥24 nodes. On survival analysis, patients with ≥24 nodes had better survival across all N stages compared to other groups (P < .001). Lymph node harvest ≥24 nodes was independently associated with improved overall survival compared to 12 to 23 nodes (hazard ratio 0.82; 95% confidence interval, 0.80-0.85).
Lymph node harvest ≥24 nodes is associated with improved survival in colorectal cancer patients. These data may provide indirect evidence for a more extensive lymphadenectomy for colon cancer.
目前结直肠癌手术中淋巴结清扫的标准可能不够充分。更高的淋巴结检出率可能会提高生存率，但优化生存所需的淋巴结数量尚不清楚。本研究的目的是探讨非转移性结肠腺癌患者接受结肠切除术时淋巴结检出率与总生存率之间的关系。
本研究通过查询 2010 年至 2014 年国家癌症数据库，纳入非转移性结肠腺癌接受结肠切除术的患者。采用调整后的限制性立方样条来模拟淋巴结检出率与总生存率之间的非线性关系。Cox 比例风险模型确定总生存率的独立预测因素。
共纳入 261423 例患者。限制性立方样条表明，调整后的总生存率在 24 个淋巴结后趋于稳定。患者被分为<12、12-23 和≥24 个淋巴结。生存分析显示，与其他组相比，N 分期各阶段的≥24 个淋巴结的患者具有更好的生存（P<0.001）。与 12-23 个淋巴结相比，淋巴结检出≥24 个与总生存率的提高独立相关（风险比 0.82；95%置信区间，0.80-0.85）。
淋巴结检出≥24 个与结直肠癌患者的生存改善相关。这些数据可能为结肠癌更广泛的淋巴结清扫提供间接证据。
