Clarunis Visceral Surgery Center, St. Clara Hospital & University Hospital Basel, Basel, Switzerland.
Department of Surgery, Kantonsspital Olten, Olten, Switzerland.
Int J Colorectal Dis. 2021 Apr;36(4):779-789. doi: 10.1007/s00384-021-03835-8. Epub 2021 Jan 16.
Nodal status in colorectal cancer (CRC) is an important prognostic factor, and adequate lymph node (LN) staging is crucial. Whether the number of resected and analysed LN has a direct impact on overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) is much discussed. Guidelines request a minimum number of 12 LN to be analysed. Whether that threshold marks a prognostic relevant cut-off remains unknown.
Patients operated for stage I-III CRC were identified from a prospectively maintained database. The impact of the number of analysed LN on OS, CSS and DFS was assessed using Cox regression and propensity score analysis.
Of the 687 patients, 81.8% had ≥ 12 LN resected and analysed. Median LN yield was 17.0 (IQR 13.0-23.0). Resection and analysis of ≥ 12 LN was associated with improved OS (HR = 0.73, 95% CI: 0.56-0.95, p = 0.033), CSS (HR 0.52, 95% CI: 0.31-0.85, p = 0.030) and DFS (HR = 0.73, 95% CI: 0.57-0.95, p = 0.030) in multivariate Cox analysis. After adjusting for biasing factors with propensity score matching, resection of ≥ 12 LN was significantly associated with improved OS (HR = 0.59; 95% CI: 0.43-0.81; p = 0.002), CSS (HR = 0.34; 95% CI: 0.20-0.60; p < 0.001) and DFS (HR = 0.55; 95% CI: 0.41-0.74; p < 0.001) compared to patients with < 12 LN.
Eliminating biasing factors by a propensity score matching analysis underlines the prognostic importance of the number of analysed LN. The set threshold marks the minimum number of required LN but nevertheless represents a cut-off regarding outcome in stage I-III CRC. This analysis therefore highlights the significance and importance of adherence to surgical oncological standards.
结直肠癌（CRC）的淋巴结状态是一个重要的预后因素，充分的淋巴结（LN）分期至关重要。切除和分析的 LN 数量是否直接影响总生存（OS）、癌症特异性生存（CSS）和无病生存（DFS），这一点存在很多争议。指南要求分析至少 12 个 LN。该阈值是否标志着具有预后意义的截止值仍不清楚。
从一个前瞻性维护的数据库中确定了接受 I-III 期 CRC 手术的患者。使用 Cox 回归和倾向评分分析评估分析的 LN 数量对 OS、CSS 和 DFS 的影响。
在 687 名患者中，81.8%的患者切除和分析了≥12 个 LN。LN 中位数为 17.0（IQR 13.0-23.0）。切除和分析≥12 个 LN 与改善 OS（HR=0.73，95%CI：0.56-0.95，p=0.033）、CSS（HR 0.52，95%CI：0.31-0.85，p=0.030）和 DFS（HR=0.73，95%CI：0.57-0.95，p=0.030）有关。在多变量 Cox 分析中，通过倾向评分匹配校正偏倚因素后，切除≥12 个 LN 与改善 OS（HR=0.59；95%CI：0.43-0.81；p=0.002）、CSS（HR=0.34；95%CI：0.20-0.60；p<0.001）和 DFS（HR=0.55；95%CI：0.41-0.74；p<0.001）显著相关。与切除<12 个 LN 的患者相比。
通过倾向评分匹配分析消除偏倚因素，强调了分析的 LN 数量的预后重要性。该设定阈值标记了所需 LN 的最小数量，但仍然是 I-III 期 CRC 结果的截止值。因此，该分析强调了遵守手术肿瘤学标准的意义和重要性。
