Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan.
Langenbecks Arch Surg. 2022 Aug;407(5):2011-2019. doi: 10.1007/s00423-022-02525-5. Epub 2022 May 2.
Main lymph node metastasis (LNM) dissection of transverse colon (TC) cancer is a difficult surgical procedure. Nonetheless, the main LNM ratio and the benefit of main lymph node (LN) dissection in TC cancer were unclear. This study aimed to identify high-risk patients for LNM and to evaluate the benefit of LN dissection in TC cancer.
Data for 26,552 colorectal cancer patients between 2007 and 2011 were obtained from the JSCCR database. Of these, 871 stage I-III TC cancer patients underwent surgery with radical LN dissection. These patients were evaluated using the index of estimated benefit from lymph node dissection (IEBLD), where IEBLD = (LNM ratio of each LN station) × (5-year overall survival (OS) rate of the patients with LNM) × 100.
None of the patients with depth of invasion pT1-2 had main LNM. The presence of main LNM was associated with depth of invasion pT4, CEA-4H (carcinoembryonic antigen 4 times higher than preoperative cutoff value), or type 3, and 323 patients (37.1%) who had these factors were high-risk patients for main LNM. In these high-risk patients, the LNM ratio, 5-year OS rate of patients with LNM and IEBLD values, respectively, were 43.9%, 70.3%, and 30.5 for the pericolic LN; 20.3%, 66.0%, and 15.1 for the intermediate LN; and 9.6%, 58.5%, and 5.6 for the main LN.
Main LNM is associated with depth of invasion pT4, CEA-4H, or type 3. The IEBLD for the main LN of high-risk TC cancer patients was over 5.
横结肠癌（TC）的主淋巴结转移（LNM）解剖是一项困难的手术操作。然而，TC 癌的主 LNM 比例和主淋巴结（LN）解剖的获益尚不明确。本研究旨在确定 LNM 的高危患者，并评估 TC 癌中 LN 解剖的获益。
从 JSCCR 数据库中获取了 2007 年至 2011 年间 26552 例结直肠癌患者的数据。其中，871 例 I-III 期 TC 癌患者接受了根治性 LN 解剖手术。使用淋巴结解剖获益估计指数（IEBLD）对这些患者进行评估，IEBLD=（每个 LN 站的 LNM 比例）×（有 LNM 患者的 5 年总生存（OS）率）×100。
无任何 pT1-2 浸润深度的患者有主 LNM。主 LNM 的存在与浸润深度 pT4、CEA-4H（癌胚抗原比术前截止值高 4 倍）或类型 3 相关，有 323 例（37.1%）存在这些因素的患者为主 LNM 的高危患者。在这些高危患者中，LNM 比例、有 LNM 的患者 5 年 OS 率和 IEBLD 值分别为结肠旁 LN 为 43.9%、70.3%和 30.5%；中间 LN 为 20.3%、66.0%和 15.1%；主 LN 为 9.6%、58.5%和 5.6%。
主 LNM 与浸润深度 pT4、CEA-4H 或类型 3 相关。高危 TC 癌患者主 LN 的 IEBLD 超过 5。
