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术前放化疗后行根治性切除术治疗局部进展期直肠癌患者的淋巴结比率对预后的影响。

Prognostic Impact of Lymph Node Ratio in Patients Undergoing Preoperative Chemoradiotherapy Followed by Curative Resection for Locally Advanced Rectal Cancer.

机构信息

Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.

Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Republic of Korea

出版信息

In Vivo. 2020 May-Jun;34(3):1247-1253. doi: 10.21873/invivo.11898.


DOI:10.21873/invivo.11898
PMID:32354915
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7279814/
Abstract

BACKGROUND/AIM: To analyze the prognostic significance of nodal status in patients undergoing preoperative chemoradiotherapy (CRT) followed by curative resection for locally advanced rectal cancer. PATIENTS AND METHODS: Between 2000 and 2015, 80 consecutive patients with rectal cancer underwent preoperative CRT followed by curative resection. The lymph node ratio (LNR) was defined as the number of positive lymph nodes (LNs) divided by the examined LNs, and log odds of positive lymph nodes (LODDS) was the log of the ratio between positive and negative LNs. The prognostic value of these indicators was evaluated in terms of overall (OS) and disease-free (DFS) survival. RESULTS: The median follow-up period for patients overall was 59 months (range=11-190 months). The median number of examined LNs and number of positive LNs were 10 (range=1-29) and 2 (range=1-27), respectively, and the median LNR and LODDS values were 0.0 (range=0.0-0.96) and -1.0 (range=-1.7-1.3), respectively. The 5-year OS and DFS were 83% and 64%, respectively. In multivariate analysis, LNR was an independent prognostic factor in terms OS (p=0.041) but not for DFS (p=0.075). LODDS was not significantly associated with OS or DFS. In patients with clinical stage III rectal cancer, LNR was significantly associated with OS and DFS when the number of evaluated LNs was greater than 12 (p=0.038 for OS, p=0.006 for DFS). CONCLUSION: Our study suggests that LNR is a more effective prognostic factor than LODDS in terms of predicting survival. LNR was a significant predictor for survival for patients with clinical stage III rectal cancer with >12 harvested LNs.

摘要

背景/目的:分析接受术前放化疗(CRT)后行根治性切除术的局部晚期直肠癌患者的淋巴结状态的预后意义。

患者和方法:2000 年至 2015 年间,80 例直肠癌患者接受了术前 CRT 后行根治性切除术。淋巴结比率(LNR)定义为阳性淋巴结(LNs)的数量除以检查的 LNs,对数阳性淋巴结(LODDS)为阳性 LNs 与阴性 LNs 之间的比值的对数。评估这些指标在总体(OS)和无病(DFS)生存方面的预后价值。

结果:患者的中位随访时间为 59 个月(范围=11-190 个月)。中位检查 LNs 数和阳性 LNs 数分别为 10(范围=1-29)和 2(范围=1-27),中位 LNR 和 LODDS 值分别为 0.0(范围=0.0-0.96)和-1.0(范围=-1.7-1.3)。5 年 OS 和 DFS 分别为 83%和 64%。多变量分析显示,LNR 是 OS 的独立预后因素(p=0.041),但不是 DFS 的独立预后因素(p=0.075)。LODDS 与 OS 或 DFS 无显著相关性。在临床分期为 III 期的直肠癌患者中,当评估的 LNs 数大于 12 时,LNR 与 OS 和 DFS 显著相关(OS:p=0.038,DFS:p=0.006)。

结论:我们的研究表明,LNR 是预测生存的比 LODDS 更有效的预后因素。对于有>12 个阳性 LNs 的临床分期为 III 期的直肠癌患者,LNR 是生存的显著预测因素。

相似文献

[1]
Prognostic Impact of Lymph Node Ratio in Patients Undergoing Preoperative Chemoradiotherapy Followed by Curative Resection for Locally Advanced Rectal Cancer.

In Vivo. 2020

[2]
Lymph node ratio is an independent prognostic factor in node positive rectal cancer patients treated with preoperative chemoradiotherapy followed by curative resection.

Asian Pac J Cancer Prev. 2014

[3]
Prognostic Value of Lymph Node Ratio in Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision.

Medicine (Baltimore). 2016-3

[4]
Lymph node ratio is an independent prognostic factor in patients with rectal cancer treated with preoperative chemoradiotherapy and curative resection.

Eur J Surg Oncol. 2012-3-30

[5]
The Log Odds of Positive Lymph Nodes Stratifies and Predicts Survival of High-Risk Individuals Among Stage III Rectal Cancer Patients.

Oncologist. 2016-4

[6]
lymph node ratio as a prognostic factor in patients with stage III rectal cancer treated with total mesorectal excision followed by chemoradiotherapy.

Int J Radiat Oncol Biol Phys. 2009-7-1

[7]
Prognostic value of lymph node ratios in node positive rectal cancer treated with preoperative chemoradiation.

Asian Pac J Cancer Prev. 2013

[8]
Log odds of positive lymph nodes is prognostically equivalent to lymph node ratio in non-metastatic colon cancer.

BMC Cancer. 2020-8-14

[9]
Impact of Lymph Node Ratio on Oncologic Outcomes in ypStage III Rectal Cancer Patients Treated with Neoadjuvant Chemoradiotherapy followed by Total Mesorectal Excision, and Postoperative Adjuvant Chemotherapy.

PLoS One. 2015-9-18

[10]
Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy.

World J Gastroenterol. 2015-3-21

引用本文的文献

[1]
Construction of a new clinical staging system for colorectal cancer based on the lymph node ratio: A validation study.

Front Surg. 2022-8-25

[2]
Prognostic value of lymph node ratio in resectable rectal cancer after preoperative short-course radiotherapy-results from randomized clinical trial.

Langenbecks Arch Surg. 2022-11

[3]
Log odds of positive lymph nodes as a novel prognostic predictor for colorectal cancer: a systematic review and meta-analysis.

BMC Cancer. 2022-3-18

本文引用的文献

[1]
Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2016.

Cancer Res Treat. 2019-3-18

[2]
Role of lymph node yield and lymph node ratio in predicting outcomes in non-metastatic colorectal cancer.

BJS Open. 2018-8-8

[3]
The impact of log odds of positive lymph nodes (LODDS) in colon and rectal cancer patient stratification: a single-center analysis of 323 patients.

Updates Surg. 2018-3

[4]
Colorectal cancer statistics, 2017.

CA Cancer J Clin. 2017-3-1

[5]
Association of the preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with lymph node metastasis and recurrence in patients with medullary thyroid carcinoma.

Medicine (Baltimore). 2016-10

[6]
LODDS is superior to lymph node ratio for the prognosis of node-positive rectal cancer patients treated with preoperative radiotherapy.

Tumori. 2017-1-21

[7]
The prognostic impact of the log odds of positive lymph nodes in colon cancer.

Colorectal Dis. 2014-11

[8]
Metastatic axillary lymph node ratio (LNR) is prognostically superior to pN staging in patients with breast cancer--results for 804 Chinese patients from a single institution.

Asian Pac J Cancer Prev. 2013

[9]
Qualitative and quantitative issues of lymph nodes as prognostic factor in colon cancer.

Dig Surg. 2013

[10]
The lymph node ratio as a prognostic factor for gastric cancer.

Acta Oncol. 2013-1-15

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