Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Medical Foundation, Chiayi Branch, No. 6, Sec. West, Chia-Pu Road, Putz City, Chiayi Hsien, 613, Taiwan.
Graduate Institute of Clinical Medicine, Chang Gung University, Linkuo, Taiwan.
BMC Cancer. 2022 Jan 31;22(1):126. doi: 10.1186/s12885-021-09154-z.
The purpose was to examine the effect of negative lymph nodes (NLN) number on survival in stage III colon cancer. To reduce the interference of acute inflammation, we included patients with stage III colon cancer who had undergone elective surgery and excluded those who had tumor perforation, obstruction, ischemia, or massive tumor bleeding.
This retrospective cohort study included 2244 patients with stage III colon cancer between 1995 and 2016 at a single center. The effect of NLN on 5-year relapse-free survival (RFS), 5-year overall survival (OS), and comparison of multivariate factors was assessed according to tumor locations.
The two optimal cutoff values of NLN for proximal and distal colon, namely 27 and 12, were determined by plotting the time-dependent receiver operating characteristic curve. Overall, 499 of 891 and 1020 of 1353 patients with right-side and left-side colon cancer, respectively, had high NLN. In right-side colon cancer, patients with high NLN (≥ 27) had superior OS (74.9% vs. 62.7%, P < 0.001) and RFS (75.0% vs. 61.9%, P < 0.001) than did those with low NLN. Moreover, in left-side colon cancer, patients with high NLN (≥12) experienced significantly superior OS (80.8% vs. 68.6%, P < 0.001) and RFS (77.3% vs. 66.2%, P < 0.001) than did those with low NLN. Among the different subgroups of stage III colon cancer, the high NLN group showed significantly superior RFS and OS in stage IIIB (RFS: 77.0% vs. 68.0%, P = 0.001; OS: 78.6% vs. 67.9%, P < 0.001) and IIIC (RFS: 58.2% vs. 44.1%, P = 0.001; OS: 65.7% vs. 51.1%, P < 0.001) colon cancer. However, in stage IIIA colon cancer, high NLN only showed survival benefit in OS (91.5% vs. 89.8%, P = 0.041). Multivariate analyses confirmed that high NLN, high carcinoembryonic antigen (≥ 5 ng/mL) level, and stage IIIC status are three independent prognostic factors in both the proximal and distal colon.
NLN is a crucial prognostic factor for stage III colon cancer in various tumor locations or in the subgroups of stage III disease. In advanced stage III colon cancer, the importance of NLN and its role in anti-cancer immune response could be highlighted.
本研究旨在探讨阴性淋巴结（NLN）数量对 III 期结肠癌患者生存的影响。为了减少急性炎症的干扰，我们纳入了接受择期手术的 III 期结肠癌患者，排除了肿瘤穿孔、梗阻、缺血或大量肿瘤出血的患者。
本回顾性队列研究纳入了 1995 年至 2016 年在单中心接受治疗的 2244 例 III 期结肠癌患者。根据肿瘤位置评估 NLN 对 5 年无复发生存率（RFS）、5 年总生存率（OS）和多因素因素比较的影响。
通过绘制时间依赖性受试者工作特征曲线，确定了近端和远端结肠癌 NLN 的两个最佳截断值，分别为 27 和 12。总体而言，右半结肠癌中有 499 例（891 例中的 56.3%）和左半结肠癌中有 1020 例（1353 例中的 75.5%）患者的 NLN 较高。在右半结肠癌中，NLN 较高（≥27）的患者 OS（74.9%比 62.7%，P<0.001）和 RFS（75.0%比 61.9%，P<0.001）均优于 NLN 较低的患者。此外，在左半结肠癌中，NLN 较高（≥12）的患者 OS（80.8%比 68.6%，P<0.001）和 RFS（77.3%比 66.2%，P<0.001）均优于 NLN 较低的患者。在不同分期的 III 期结肠癌亚组中，NLN 较高的患者在 IIIB 期（RFS：77.0%比 68.0%，P=0.001；OS：78.6%比 67.9%，P<0.001）和 IIIC 期（RFS：58.2%比 44.1%，P=0.001；OS：65.7%比 51.1%，P<0.001）的 RFS 和 OS 均显著改善。然而，在 IIIA 期结肠癌中，NLN 仅在 OS 方面显示出生存获益（91.5%比 89.8%，P=0.041）。多因素分析证实，NLN、高癌胚抗原（≥5ng/mL）水平和 IIIC 期是近端和远端结肠癌的三个独立预后因素。
NLN 是各种肿瘤位置或 III 期疾病亚组中 III 期结肠癌的重要预后因素。在晚期 III 期结肠癌中，NLN 的重要性及其在抗癌免疫反应中的作用可能会更加突出。
