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淋巴结比率对结直肠癌患者手术结局的影响。

The effect of lymph node ratio on the surgical outcomes in patients with colorectal cancer.

机构信息

Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.

出版信息

Sci Rep. 2024 Jul 31;14(1):17689. doi: 10.1038/s41598-024-68576-4.


DOI:10.1038/s41598-024-68576-4
PMID:39085386
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11291744/
Abstract

The current study aimed to evaluate the effect of lymph node ratio (LNR) on the short-term and long-term outcomes of colorectal cancer (CRC) patients who underwent radical CRC surgery. We retrospectively collected CRC patients who underwent radical surgery from Jan 2011 to Jan 2020 in a single-center hospital. The patients were divided into the high LNR group and the low group according to the median. The baseline information and the short-term outcomes were compared between the high group and the low group. Univariate and multivariate logistic regression was performed to analyze the independent predictors for overall survival (OS) and disease-free survival (DFS). A 1:1 proportional propensity score matching (PSM) was used to reduce the selection bias between the two groups. Kaplan-Meier method was used to estimate the OS and DFS between the two groups in different T stages. A total of 1434 CRC patients undergoing radical surgery were enrolled in this study, and there were 730 (50.9%) patients in the low LNR group and 704 (49.1%) patients in the high LNR group. After the PSM, there were 618 patients in both groups, the baseline characteristics between the two groups had no significant difference (p > 0.05). After comparing the Surgery-related information and The Short-term outcomes, the high LNR group had a longer hospital stay (after PSM, p < 0.01). In univariate and multivariate logistic regression analyses, age (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor location (univariate analysis, p = 0.020; multivariate analysis, p = 0.024), lymph-vascular space invasion (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), cancer nodules (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor size (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), LNR (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), and overall complications (univariate analysis, p < 0.01; multivariate analysis, p < 0.01) were independent risk factors for OS, and age (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor location (univariate analysis, p = 0.032; multivariate analysis, p = 0.031), T stage (univariate analysis, p < 0.01; multivariate analysis, p = 0.014), lymph-vascular space invasion (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), cancer nodules (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), LNR (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), and overall complications (univariate analysis, p < 0.01; multivariate analysis, p < 0.01) were identified as independent risk factors for DFS. The high LNR group had a worse OS in T3 (p < 0.01) and T4 (p < 0.01) as well as a worse DFS in T3 (p < 0.01) and T4 (p < 0.01). No association was found between LNR and postoperative complications, but the high LNR group had a longer hospital stay. LNR was identified as an independent predictor for OS and DFS. Furthermore, high LNR had a worse OS and DFS under T3 and T4 stages. Therefore, LNR was more prognostically significant for CRC patients under T3 and T4 stages.

摘要

本研究旨在评估淋巴结比率(LNR)对接受根治性结直肠癌(CRC)手术的 CRC 患者短期和长期结局的影响。我们回顾性地收集了 2011 年 1 月至 2020 年 1 月在一家单中心医院接受根治性手术的 CRC 患者。根据中位数将患者分为高 LNR 组和低组。比较高组和低组之间的基线信息和短期结局。使用单因素和多因素逻辑回归分析总生存(OS)和无病生存(DFS)的独立预测因素。使用 1:1 比例倾向评分匹配(PSM)来减少两组之间的选择偏差。Kaplan-Meier 法用于估计不同 T 分期的两组之间的 OS 和 DFS。共纳入 1434 例接受根治性手术的 CRC 患者,其中低 LNR 组 730 例(50.9%),高 LNR 组 704 例(49.1%)。经过 PSM 后,两组各有 618 例患者,两组之间的基线特征无显著差异(p > 0.05)。比较手术相关信息和短期结局后,高 LNR 组的住院时间较长(PSM 后,p < 0.01)。在单因素和多因素逻辑回归分析中,年龄(单因素分析,p < 0.01;多因素分析,p < 0.01)、肿瘤位置(单因素分析,p = 0.020;多因素分析,p = 0.024)、淋巴管血管间隙侵犯(单因素分析,p < 0.01;多因素分析,p < 0.01)、癌结节(单因素分析,p < 0.01;多因素分析,p < 0.01)、肿瘤大小(单因素分析,p < 0.01;多因素分析,p < 0.01)、LNR(单因素分析,p < 0.01;多因素分析,p < 0.01)和总体并发症(单因素分析,p < 0.01;多因素分析,p < 0.01)是 OS 的独立危险因素,年龄(单因素分析,p < 0.01;多因素分析,p < 0.01)、肿瘤位置(单因素分析,p = 0.032;多因素分析,p = 0.031)、T 分期(单因素分析,p < 0.01;多因素分析,p = 0.014)、淋巴管血管间隙侵犯(单因素分析,p < 0.01;多因素分析,p < 0.01)、癌结节(单因素分析,p < 0.01;多因素分析,p < 0.01)、LNR(单因素分析,p < 0.01;多因素分析,p < 0.01)和总体并发症(单因素分析,p < 0.01;多因素分析,p < 0.01)是 DFS 的独立危险因素。高 LNR 组在 T3(p < 0.01)和 T4(p < 0.01)的 OS 较差,在 T3(p < 0.01)和 T4(p < 0.01)的 DFS 较差。LNR 与术后并发症无关,但高 LNR 组的住院时间较长。LNR 是 OS 和 DFS 的独立预测因素。此外,高 LNR 组在 T3 和 T4 期的 OS 和 DFS 较差。因此,LNR 对 T3 和 T4 期的 CRC 患者具有更重要的预后意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/befd/11291744/823ece30e29f/41598_2024_68576_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/befd/11291744/03528e233743/41598_2024_68576_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/befd/11291744/2a29f2e73882/41598_2024_68576_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/befd/11291744/823ece30e29f/41598_2024_68576_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/befd/11291744/03528e233743/41598_2024_68576_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/befd/11291744/2a29f2e73882/41598_2024_68576_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/befd/11291744/823ece30e29f/41598_2024_68576_Fig3_HTML.jpg

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引用本文的文献

[1]
Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi-Center Retrospective Study.

Cancer Med. 2025-4

[2]
Analysis of the predictive postoperative recurrence performance of three lymph node staging systems in patients with colon cancer.

Front Oncol. 2025-3-11

[3]
Prognostic determinants in surgical critial patients undergoing emergency surgery for Stage III or higher colorectal cancer.

Langenbecks Arch Surg. 2025-2-22

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