Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Sci Rep. 2024 Jul 31;14(1):17689. doi: 10.1038/s41598-024-68576-4.
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.
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。
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