Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Cancer Med. 2023 May;12(9):10303-10314. doi: 10.1002/cam4.5761. Epub 2023 Mar 20.
The relationship between the radiological lymph node (rLN) size and survival outcome in node-negative rectal cancer is still uncertain. In this study, we aimed to explore the role of enlarged rLN in predicting the survival of node-negative rectal cancers.
We retrospectively reviewed the records of 722 node-negative rectal cancer who underwent curative resection. Factors associated with DFS (disease-free survival) and CSS (cancer-specific survival) were assessed with univariate and multivariate analysis. Survival analysis was performed according to presence with or without enlarged rLN. Combining rLN with NLR as a new index-inflammation immune score (IIS) for predicting survival. Comparing different models to assess the predictive powers.
A total of 119 patients had tumor recurrence and 73 patients died due to cancer. Patients with enlarged rLN (≥5 mm) was significantly associated with better DFS (HR:0.517, 95%CI:0.339-0.787, p = 0.002) and CSS (HR:0.43, 95%CI:0.242-0.763, p = 0.004). The risk factors of recurrence were rLN, neutrophil-lymphocyte ratio (NLR), CEA level, and distance from the anal verge. The risk of recurrence increased by 1.88- and 2.83-fold for the high score in IIS compared with the low and intermediate score group (All p < 0.001). Similarly, the high score in IIS also increased the risk of cancer-specific death. In the model comparison, the AIC and LR were improved by including the rLN into the NLR model for DFS and CSS prediction (All p < 0.05).
Node-negative rectal cancer patients with enlarged rLN had a better survival outcome. IIS might be a more comprehensive and complete inflammation immune index for survival prediction.
在淋巴结阴性直肠癌中，放射学淋巴结（rLN）大小与生存结果之间的关系尚不确定。本研究旨在探讨 rLN 增大在预测淋巴结阴性直肠癌生存中的作用。
我们回顾性分析了 722 例接受根治性切除术的淋巴结阴性直肠癌患者的记录。采用单因素和多因素分析评估与无病生存（DFS）和癌症特异性生存（CSS）相关的因素。根据是否存在 rLN 增大进行生存分析。将 rLN 与 NLR 结合作为预测生存的新指标-炎症免疫评分（IIS）。比较不同模型以评估预测能力。
共有 119 例患者发生肿瘤复发，73 例患者死于癌症。rLN 增大（≥5mm）的患者 DFS（HR：0.517，95%CI：0.339-0.787，p=0.002）和 CSS（HR：0.43，95%CI：0.242-0.763，p=0.004）显著更好。复发的危险因素是 rLN、中性粒细胞-淋巴细胞比（NLR）、CEA 水平和肛缘距离。与低和中 IIS 评分组相比，IIS 高分组的复发风险分别增加了 1.88 倍和 2.83 倍（均 p<0.001）。同样，IIS 高分也增加了癌症特异性死亡的风险。在模型比较中，将 rLN 纳入 NLR 模型可改善 DFS 和 CSS 预测的 AIC 和 LR（均 p<0.05）。
rLN 增大的淋巴结阴性直肠癌患者生存结局更好。IIS 可能是一种更全面、更完整的炎症免疫预测生存的指标。
