Alexandrescu Sorin Tiberiu, Selaru Florin M, Diaconescu Andrei S, Zlate Cristian A, Blanita Diana, Grigorie Razvan T, Zarnescu Narcis O, Herlea Vlad, Popescu Irinel
Dan Setlacec Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Soseaua Fundeni, 258, building A, 3rd floor, sector 2, 022328, Bucharest, Romania.
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
J Gastrointest Surg. 2022 Jan;26(1):141-149. doi: 10.1007/s11605-021-05079-x. Epub 2021 Jul 13.
Recent studies suggest that lymph node ratio (LNR) has significantly better prognostic power than N-status in patients with colorectal cancer, in particular when the number of evaluated lymph nodes (LNs) was insufficient. The aim of this study was to assess the prognostic value of LNR in patients with resected synchronous colorectal liver metastases (SCLMs) and less than 12 examined LNs.
A prospectively maintained database of patients with resected SCLMs was queried for patients with less than 12 LNs evaluated at the time of surgery. X-tile software was used to determine the LNR cutoff value able to divide the patients in two subgroups with distinct prognosis. Overall survival (OS) and disease-free survival (DFS) rates were compared by log-rank test. A multivariate Cox regression analysis identified independent prognostic factors.
A cutoff LNR value of 0.22 divided patients into Low-LNR group (35 patients) and High-LNR group (36 patients). Both OS and DFS rates were significantly higher in Low-LNR group than those in High-LNR group. Independent predictors of poor OS were High-LNR (HR: 2.841, 95% CI: 1.480-5.453, p value = 0.002), bilobar SCLMs (HR: 2.253, 95% CI: 1.144-4.437, p value = 0.019) and lack of adjuvant chemotherapy (HR: 2.702, 95% CI: 1.448-5.043, p value = 0.002), while the only independent predictor of poor DFS was High-LNR (HR: 2.531, 95% CI: 1.259-5.090, p value = 0.009).
LNR > 0.22 was independently associated with poor OS and DFS in patients with resected SCLMs and less than 12 evaluated LNs.
近期研究表明，在结直肠癌患者中，淋巴结比率（LNR）的预后能力显著优于淋巴结状态（N分期），尤其是在评估的淋巴结数量不足时。本研究的目的是评估LNR在接受手术切除的同步性结直肠癌肝转移（SCLM）且检查的淋巴结少于12枚的患者中的预后价值。
查询前瞻性维护的接受手术切除的SCLM患者数据库，以获取手术时评估的淋巴结少于12枚的患者。使用X-tile软件确定能够将患者分为两个预后不同亚组的LNR临界值。通过对数秩检验比较总生存（OS）率和无病生存（DFS）率。多因素Cox回归分析确定独立的预后因素。
LNR临界值为0.22时，将患者分为低LNR组（35例）和高LNR组（36例）。低LNR组的OS率和DFS率均显著高于高LNR组。OS不良的独立预测因素为高LNR（HR：2.841，95%CI：1.480 - 5.453，p值 = 0.002）、双叶SCLM（HR：2.253，95%CI：1.144 - 4.437，p值 = 0.019）和未接受辅助化疗（HR：2.702，95%CI：1.448 - 5.043，p值 = 0.002），而DFS不良的唯一独立预测因素为高LNR（HR：2.531，95%CI：1.259 - 5.090，p值 = 0.009）。
LNR > 0.22与接受手术切除的SCLM且评估的淋巴结少于12枚的患者的OS和DFS不良独立相关。
