Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
World J Surg. 2021 May;45(5):1514-1525. doi: 10.1007/s00268-020-05933-0. Epub 2021 Jan 21.
To define the incidence of gastroepiploic lymph node (GLN) metastasis in patients with cancer of the transverse colon, including the hepatic flexure, and to identify the preoperative predictors of GLN involvement in a large-volume center in China.
This retrospective monocentric cross-sectional study respected the STROBE statement. Of 3208 consecutive patients who underwent colon cancer resection, a total of 371 patients with cancer of the transverse colon including the hepatic flexure who underwent complete mesocolic excision and GLN resection in our center were retrospectively reviewed between November 2010 and November 2017. Logistic regression was performed to identify predictors of GLN metastasis. Endoscopic obstruction was defined as a luminal obstruction of the colon severe enough to prevent the colonoscope from passing beyond the tumor regardless of the presenting symptoms.
The GLN involvement rate was 4.0 (2.0-6.1)%. Patients who had GLN involvement had a significantly higher rate of endoscopic obstruction (P = 0.030), higher rate of signet ring adenocarcinoma or lymphovascular invasion (P < 0.05), higher preoperative CEA level (P = 0.037), more advanced pN stage (P < 0.001) and more advanced M stage (P = 0.003) than the patients without GLN involvement. ROC curve analyses showed that the cutoff value for CEA was 17.0 ng/ml (46.7% sensitivity, 84.3% specificity, P = 0.037) for the prediction of GLN metastasis. Multivariate analysis showed that endoscopic obstruction, signet ring adenocarcinoma, a CEA level ≥17 ng/ml and M1 stage were independently correlated with the GLN metastasis.
The incidence rate of GLN metastasis was low. To the best of our knowledge, the present study was the first to evaluate the preoperative predictors of GLN metastasis. Combinations of predictive factors may be useful for stratifying patients at high risk of GLN metastasis.
确定包括肝曲部在内的横结肠癌患者胃网膜淋巴结（GLN）转移的发生率，并在我国的大容量中心确定术前 GLN 受累的预测因子。
这项回顾性单中心横断面研究符合 STROBE 声明。在 2010 年 11 月至 2017 年 11 月期间，对在我们中心接受完全中结肠切除术和 GLN 切除术的 371 例包括肝曲部在内的横结肠癌患者进行了回顾性分析，共纳入了 3208 例连续接受结肠癌切除术的患者。采用 logistic 回归分析确定 GLN 转移的预测因子。内镜阻塞定义为结肠腔严重阻塞，即使没有出现症状，结肠镜也无法通过肿瘤。
GLN 受累率为 4.0（2.0-6.1）%。GLN 受累的患者内镜阻塞发生率明显更高（P=0.030），印戒细胞癌或淋巴管侵犯发生率更高（P<0.05），术前 CEA 水平更高（P=0.037），pN 分期更高（P<0.001），M 分期更高（P=0.003）。ROC 曲线分析显示，CEA 截断值为 17.0ng/ml 时（46.7%的敏感性，84.3%的特异性，P=0.037）预测 GLN 转移的准确率最高。多变量分析显示，内镜阻塞、印戒细胞癌、CEA 水平≥17ng/ml 和 M1 期与 GLN 转移独立相关。
GLN 转移的发生率较低。据我们所知，本研究首次评估了 GLN 转移的术前预测因子。预测因素的组合可能有助于对 GLN 转移风险较高的患者进行分层。
