Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Int J Colorectal Dis. 2021 Oct;36(10):2205-2214. doi: 10.1007/s00384-021-03990-y. Epub 2021 Jul 24.
The purpose of the study was to compare staging of stage II colon cancer using the number of retrieved lymph nodes (RN) to current TNM staging for stratification of prognosis.
The subjects were 6307 patients with stage II colon cancer who underwent curative resection at 24 Japanese institutions. The cutoff for the number of RN was established using Akaike information criterion (AIC) values for relapse-free survival (RFS) and overall survival (OS). Comparison of survival using TNM and T + RN (TRN) staging was performed using a Cox proportional hazards regression model.
AIC was lowest for 14 retrieved lymph nodes for RFS and OS. This number was used as the cutoff. In multivariate analysis, age (≥ 69), male gender, V1, CEA (> 5), pT (T4a, T4b), and RN-L were independent factors associated with RFS and OS. Six combinations of pT and RN categories were used to establish three subgroups: TRN stages IIA, IIB, and IIC. The 5-year RFS was 83.9%, 72.3%, and 71.8% in TNM stages IIA, IIB, and IIC; and 86.0%, 76.9%, and 60.3% in TRN stages IIA, IIB, and IIC. The 5-year OS was 90.0%, 81.3%, and 82.6% for the TNM stages; and 91.6%, 85.0%, and 71.9% for the TRN stages. The AIC for RFS was lower for TRN (22,318.2) than for TNM (22,390.6), and that for OS was also lower for TRN (16,285.3) than for TNM (16,355.1).
Stage II colon cancer staging using the number of retrieved lymph nodes may be superior to current TNM staging for prognosis stratification.
本研究旨在比较使用检出淋巴结（RN）数量对 II 期结肠癌进行分期，以替代当前的 TNM 分期，从而对预后进行分层。
本研究纳入了在日本 24 家医疗机构接受根治性切除术的 6307 例 II 期结肠癌患者。采用复发无进展生存（RFS）和总生存（OS）的赤池信息量准则（AIC）值来确定 RN 数量的截断值。采用 Cox 比例风险回归模型比较 TNM 分期和 T+RN（TRN）分期的生存情况。
AIC 最低的是用于 RFS 和 OS 的 14 个检出的淋巴结。以此数量作为截断值。多变量分析显示，年龄（≥69 岁）、男性、V1、CEA（＞5）、pT（T4a、T4b）和 RN-L 是与 RFS 和 OS 相关的独立因素。根据 pT 和 RN 分类的 6 种组合，建立了 3 个亚组：TRN 分期 IIA、IIB 和 IIC。TNM 分期 IIA、IIB 和 IIC 的 5 年 RFS 分别为 83.9%、72.3%和 71.8%，TRN 分期 IIA、IIB 和 IIC 的 5 年 RFS 分别为 86.0%、76.9%和 60.3%。TNM 分期的 5 年 OS 分别为 90.0%、81.3%和 82.6%，TRN 分期的 5 年 OS 分别为 91.6%、85.0%和 71.9%。RFS 的 AIC 对于 TRN（22318.2）来说低于 TNM（22390.6），OS 的 AIC 对于 TRN（16285.3）来说也低于 TNM（16355.1）。
使用检出淋巴结数量对 II 期结肠癌进行分期可能优于当前的 TNM 分期，有助于对预后进行分层。
