Department of Colorectal Surgery, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China.
Department of Pathology, Institute of Cancer and Basic Medicine (ICBM) of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, 1 Banshan E. road, Hangzhou, 310011, Zhejiang, China.
Int J Colorectal Dis. 2020 Apr;35(4):623-631. doi: 10.1007/s00384-019-03483-z. Epub 2020 Jan 30.
Adequate lymphadenectomy is critical for accurate nodal staging and planning adjuvant therapy in colon cancer. However, the optimal lymph node (LN) yield for stage II right-sided colon cancer (RSCC) is still unclear. This population-based study aimed to determine the optimal LN yield associated with survival and LN positivity in patients with stage II RSCC.
All patients with stage II-III RSCC were identified from the Surveillance, Epidemiology, and End Results database over a 10-year interval (2006-2015). The optimal threshold for LN yield was explored using an outcome-oriented approach based on survival and LN positivity.
The median number of LNs examined for all 17,385 patients with stage II RSCC was 17 (IQR 12-23). Nineteen LNs were determined as the optimal cut-off point to maximize survival benefit from lymphadenectomy. Increased LN yield was associated with a gradual increase in the risk of node positivity, with no change after 19 nodes. Compared with patients with 19 or more LNs examined, the group with fewer LNs had a significantly poor cancer-specific survival (< 12 nodes: hazard ratio (HR) 2.26, P < 0.001; 12-18 nodes: HR 1.58, P < 0.001) and overall survival (< 12 nodes: HR 1.80, P < 0.001; 12-18 nodes: HR 1.31, P < 0.001). Similar survival results were found in the validation cohort. Patients with older age, small tumor size, and appendix and transverse colon cancer were more likely to receive inadequate LN harvest.
A minimum of 19 LNs is needed to be examined for optimal survival and adequate node staging in lymph node-negative RSCC.
充分的淋巴结清扫对于结直肠癌的准确淋巴结分期和辅助治疗计划至关重要。然而，对于右侧结肠癌（RSCC）Ⅱ期患者，最佳的淋巴结（LN）检出量仍不清楚。本基于人群的研究旨在确定与Ⅱ期 RSCC 患者生存和 LN 阳性相关的最佳 LN 检出量。
在 10 年期间（2006-2015 年），从监测、流行病学和最终结果数据库中确定所有Ⅱ-Ⅲ期 RSCC 患者。使用基于生存和 LN 阳性的结果导向方法探索 LN 检出量的最佳阈值。
所有 17385 例Ⅱ期 RSCC 患者的 LN 中位数为 17（IQR 12-23）。19 个 LN 被确定为最大程度提高淋巴结清扫术生存获益的最佳截断点。随着 LN 阳性率的逐渐增加，LN 检出量的增加与 LN 阳性率的增加相关，当 LN 检出量达到 19 个后，LN 阳性率的增加没有变化。与 LN 检出量达到 19 个或更多的患者相比，LN 检出量较少的患者癌症特异性生存显著较差（＜12 个 LN：HR 2.26，P＜0.001；12-18 个 LN：HR 1.58，P＜0.001）和总生存（＜12 个 LN：HR 1.80，P＜0.001；12-18 个 LN：HR 1.31，P＜0.001）。在验证队列中也发现了相似的生存结果。年龄较大、肿瘤较小、阑尾和横结肠癌患者更有可能接受不足的 LN 采集。
对于无淋巴结转移的 RSCC，为了获得最佳生存和充分的淋巴结分期，至少需要检查 19 个 LN。
