前哨淋巴结定位在无淋巴结转移结肠癌分期中的价值：倾向评分与中介分析

The Value of Sentinel Lymph Node Mapping for the Staging of Node-Negative Colon Cancer: Propensity Score and Mediation Analyses.

作者信息

Weixler Benjamin, Ramser Michaela, Warschkow Rene, Viehl Carsten T, Vaughan-Shaw Peter G, Zettl Andreas, Kettelhack Christoph, Zuber Markus

机构信息

From the Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité University of Medicine Berlin, Berlin, Germany.

Department of Surgery, Cantonal Hospital Olten, Olten, Switzerland.

出版信息

Ann Surg Open. 2021 Jul 26;2(3):e084. doi: 10.1097/AS9.0000000000000084. eCollection 2021 Sep.

DOI:10.1097/AS9.0000000000000084

PMID:37635823

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10455289/

Abstract

OBJECTIVES

Mediation analysis to assess the protective impact of sentinel lymph node (SLN) mapping on prognosis and survival of patients with colon cancer through a more precise evaluation of the lymph node (LN) status.

BACKGROUND

Up to 20% of patients with node-negative colon cancer develop disease recurrence. Conventional histopathological LN examination may be limited in describing the real metastatic burden of LN.

METHODS

Data of 312 patients with stage I & II colon cancer was collected prospectively. Patients were either staged using intraoperative SLN mapping with multilevel sectioning and immunohistochemical staining of the SLN or conventional techniques. The value of the SLN mapping for the detection of truly node-negative patients was assessed using Cox regression and mediation analysis.

RESULTS

SLN mapping was performed in 143 patients. Disease recurrence was observed in 13 (9.1%) patients staged with SLN mapping and in 27 (16%) staged conventionally. Five-year overall survival (OS) rate was 82.7% (95% confidence interval [CI], 76.5-89.4%) with SLN mapping compared with 65.8% (95% CI, 58.8-73.7%). Five-year cancer-specific survival (CSS) was 95.1% (95% CI, 91.3-99.0%) with SLN mapping compared with 92.5% (95% CI, 88.0-97.2%). Node-negative staging with SLN mapping was associated with significantly better OS (hazard ratio [HR], 0.64; 95% CI, 0.56-0.72; < 0.001) and CSS (HR, 0.49; 95% CI, 0.39-0.61; < 0.001) in multivariate analysis. Mediation analysis confirmed a direct protective effect of SLN mapping on OS (HR, 0.78; 95% CI, 0.52-0.96; < 0.01) and disease-free survival (DFS) (HR, 0.75; 95% CI, 0.48-0.89; < 0.01).

CONCLUSIONS

Staging performed by SLN mapping with multilevel sectioning provides more accurate results than conventional staging. The observed clinically relevant and statistically significant benefit in OS and DFS is explained by a more accurate detection of positive LN by SLN mapping.

摘要

目的

通过更精确地评估淋巴结（LN）状态，进行中介分析以评估前哨淋巴结（SLN）定位对结肠癌患者预后和生存的保护作用。

背景

高达20%的淋巴结阴性结肠癌患者会出现疾病复发。传统的组织病理学LN检查在描述LN的实际转移负担方面可能存在局限性。

方法

前瞻性收集312例I期和II期结肠癌患者的数据。患者要么采用术中SLN定位并对SLN进行多层切片和免疫组化染色进行分期，要么采用传统技术分期。使用Cox回归和中介分析评估SLN定位对检测真正淋巴结阴性患者的价值。

结果

143例患者进行了SLN定位。采用SLN定位分期的患者中有13例（9.1%）出现疾病复发，采用传统分期的患者中有27例（16%）出现疾病复发。采用SLN定位时，五年总生存率（OS）为82.7%（95%置信区间[CI]，76.5 - 89.4%），而传统分期时为65.8%（95%CI，58.8 - 73.7%）。采用SLN定位时，五年癌症特异性生存率（CSS）为95.1%（95%CI，91.3 - 99.0%），而传统分期时为92.5%（95%CI，88.0 - 97.2%）。在多因素分析中，采用SLN定位的淋巴结阴性分期与显著更好的OS（风险比[HR]，0.64；95%CI，0.56 - 0.72；P < 0.001）和CSS（HR，0.49；95%CI，0.39 - 0.61；P < 0.001）相关。中介分析证实SLN定位对OS（HR，0.78；95%CI，0.52 - 0.96；P < 0.01）和无病生存期（DFS）（HR，0.75；95%CI，0.48 - 0.89；P < 0.01）有直接保护作用。