Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin.
Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Int J Surg. 2023 Jul 1;109(7):1932-1940. doi: 10.1097/JS9.0000000000000244.
The National Quality Forum has endorsed at least 12 lymph node yield (LNY) as a surgical quality indicator in colorectal cancer (CRC), but the prognostic value of adequate lymphadenectomy has rarely been investigated for CRC patients with distant metastatic disease.
A total of 4575 CRC patients with synchronous liver metastasis who underwent primary tumor resection were identified from a Chinese registry and the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017. The Kaplan-Meier methods and Cox regression models were performed to assess the correlations between LNY and 3-year cancer-specific survival (CSS). Propensity score matching were used to confirmed the survival comparison between patients with less than 12 and of at least 12 LNY.
The retrieval of at least 12 LNY was identified in most CRC patients (SEER database, 3380/3899, 86.7%; Chinese cohort, 565/676, 83.6%). In both the SEER database and the Chinese cohort, the patients with LNY ≥12 was significantly associated with better CSS compared with patients with LNY <12 before and after propensity score matching, with all P -value less than 0.05. After controlling for the confounders, multivariate analysis demonstrated that LNY was also an independent prognostic factor for patients with distant metastasis in both cohorts. In subgroup analysis, the CSS benefit for patients with LNY ≥12 was observed across most of the subgroups.
Clinical feasibility of the 12-node threshold as a guideline quality metric of cancer care for CRC patients is necessary, and an oncologically adequate lymphadenectomy is still a critical component of high-quality surgical standard in CRC patients with distant metastases.
国家质量论坛至少认可了 12 个淋巴结检出量（LNY）作为结直肠癌（CRC）的手术质量指标，但对于远处转移性 CRC 患者，充分淋巴结清扫的预后价值很少被研究。
从中国登记处和监测、流行病学和最终结果（SEER）数据库中，确定了 2010 年至 2017 年期间 4575 例接受原发肿瘤切除术的同时性肝转移 CRC 患者。采用 Kaplan-Meier 方法和 Cox 回归模型评估 LNY 与 3 年癌症特异性生存率（CSS）之间的相关性。采用倾向评分匹配法证实 LNY<12 与≥12 的患者之间的生存比较。
在大多数 CRC 患者中，发现至少检出 12 个淋巴结（SEER 数据库 3380/3899，86.7%；中国队列 565/676，83.6%）。在 SEER 数据库和中国队列中，LNY≥12 的患者 CSS 均明显优于 LNY<12 的患者，在倾向评分匹配前后均具有统计学意义（所有 P 值均<0.05）。多变量分析显示，在两组中，LNY 也是远处转移患者的独立预后因素。亚组分析显示，在大多数亚组中，LNY≥12 的患者 CSS 获益。
对于 CRC 患者，将 12 个淋巴结作为癌症治疗质量指标的临床可行性是必要的，对于远处转移的 CRC 患者，充分的淋巴结清扫仍然是高质量手术标准的关键组成部分。
