Medical Oncology, Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514, Loures, Portugal.
Medical Oncology, Hospital da Luz Lisboa, Av. Lusíada 100, 1500-650, Lisbon, Portugal.
Surg Oncol. 2022 Aug;43:101806. doi: 10.1016/j.suronc.2022.101806. Epub 2022 Jul 9.
Guidelines recommend regional lymphadenectomy with a lymph node yield (LNY) of at least 12 lymph nodes (LN) for adequate colon cancer (CC) staging. LNY ≥22LN may improve survival, especially in right-sided CC [Lee et al., Surg Oncol, 27(3), 2018]. This multicentric retrospective cohort study evaluated the impact of LNY and tumor laterality on CC staging and survival.
Patients with stage I-III CC that underwent surgery from 2012 to 2018 were grouped according to LNY: <22 and ≥ 22. Primary outcomes were LN positivity (N+ rate) and disease-free survival (DFS). Overall survival (OS) was the secondary outcome. Exploratory analyses were performed for laterality and stage.
We included 795 patients (417 < 22LN, 378 ≥ 22LN); 53% had left-sided CC and 29%/37%/38% had stage I/II/III tumors. There was no association between LNY ≥22LN and N+ rate after adjustment for grade, T stage, lymphovascular invasion (LVI) and perineural invasion; a trend for a higher N+ rate in left-sided CC was identified (interaction p = 0.033). With a median follow-up of 63.6 months for DFS and 73.2 months for OS, 254 patients (31.9%) relapsed and 207 (26.0%) died. In multivariate analysis adjusted for age, ASA score, laparoscopic approach, T/N stage, mucinous histology, LVI and adjuvant chemotherapy, LNY ≥22LN was significantly associated with both DFS (HR 0.75, p = 0.031) and OS (HR 0.71, p = 0.025). Restricted cubic spline analysis showed a more significant benefit for right-sided CC.
LNY ≥22LN was associated with longer DFS and OS in patients with operable CC, especially for right-sided CC.
指南建议行区域淋巴结清扫术，且淋巴结获取量（LNY）至少 12 枚，以充分分期结肠癌（CC）。LNY≥22 枚可能改善生存，尤其是在右半结肠癌[Lee 等，外科学肿瘤杂志，27（3），2018]。本多中心回顾性队列研究评估了 LNY 和肿瘤侧别的影响，以了解 CC 分期和生存情况。
纳入 2012 年至 2018 年接受手术治疗的 I-III 期 CC 患者，根据 LNY 分为<22 枚和≥22 枚两组。主要结局为淋巴结阳性率（N+率）和无病生存率（DFS）。总生存率（OS）为次要结局。进行了侧别和分期的探索性分析。
共纳入 795 例患者（417 例<22 枚 LN，378 例≥22 枚 LN）；53%为左半结肠癌，29%/37%/38%为 I/II/III 期肿瘤。调整分级、T 分期、脉管侵犯（LVI）和神经周围侵犯后，LNY≥22 枚与 N+率无相关性；左半结肠癌 N+率呈升高趋势（交互 p=0.033）。DFS 随访中位数为 63.6 个月，OS 随访中位数为 73.2 个月，254 例（31.9%）患者复发，207 例（26.0%）患者死亡。多变量分析调整年龄、ASA 评分、腹腔镜方法、T/N 分期、黏液组织学、LVI 和辅助化疗后，LNY≥22 枚与 DFS（HR 0.75，p=0.031）和 OS（HR 0.71，p=0.025）显著相关。受限立方样条分析显示，右半结肠癌获益更显著。
在可手术治疗的 CC 患者中，LNY≥22 枚与 DFS 和 OS 延长相关，尤其是右半结肠癌。
