Kartal Bahadır, Tutan Mehmet Berksun
General Surgery, Hitit University Erol Olçok Training and Research Hospital, Çorum, TUR.
General Surgery, Alaca State Hospital, Çorum, TUR.
Cureus. 2024 Sep 5;16(9):e68734. doi: 10.7759/cureus.68734. eCollection 2024 Sep.
Objective This study aimed to evaluate the impact of the metastatic lymph node ratio (mtLNR) on survival outcomes and prognosis in patients with rectal carcinoma, in comparison with other clinicopathological factors. Methods A retrospective cohort analysis was conducted on 97 patients with rectal adenocarcinoma who underwent surgical treatment at Erol Olçok Training and Research Hospital between January 2017 and December 2022. The inclusion criteria consisted of patients over 18 years of age and the absence of hematological disorders or concurrent inflammatory conditions. The patients' demographic data, tumor characteristics, surgical details, lymph node (LN) status, mtLNR, and survival outcomes were analyzed. The optimal cutoff value of mtLNR for predicting mortality was determined using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier survival analysis was employed to estimate overall survival (OS) and disease-free survival (DFS), and differences between groups were evaluated using the log-rank test. The Cox proportional hazards model was used to calculate hazard ratios (HRs) for all-cause mortality. Statistical significance was set at p<0.05. Results The mean age of the patients was 70.31 ± 11.57 years, with 65.98% being male. Low anterior resection (LAR) was performed in 83.51% of the patients, and laparoscopic surgery was conducted in 26.8%. The median OS for the entire cohort was 24 months (range: 3-60). Patients were divided into two groups based on mtLNR, with the cutoff value set at 0.2183. A high mtLNR was significantly associated with poorer DFS and OS (p=0.021 and p=0.003, respectively). Moreover, patients with an mtLNR>0.2183 exhibited significantly higher rates of recurrence, lymphovascular invasion (LVI), and perineural invasion (PNI) compared to those with a lower mtLNR (all p<0.001). The optimal cutoff value of mtLNR predicted mortality with a specificity of 81.4% and a sensitivity of 48.1% (area under the curve (AUC) 0.662, p=0.012). Kaplan-Meier analysis showed a significant difference in survival between the two groups; the risk of all-cause mortality was 3.71 times higher in patients with mtLNR>0.2183 (p=0.002). Conclusion The mtLNR is a strong determinant of survival and prognosis in patients with rectal carcinoma. High mtLNR values are associated with worse survival outcomes and more aggressive tumor characteristics. The findings suggest that mtLNR should be considered in clinical decision-making processes. These results indicate that mtLNR could be a valuable prognostic tool in clinical decision-making.
目的 本研究旨在评估转移性淋巴结比率（mtLNR）对直肠癌患者生存结局和预后的影响，并与其他临床病理因素进行比较。方法 对2017年1月至2022年12月在埃罗尔·奥尔库克培训与研究医院接受手术治疗的97例直肠腺癌患者进行回顾性队列分析。纳入标准包括年龄超过18岁且无血液系统疾病或并发炎症性疾病。分析患者的人口统计学数据、肿瘤特征、手术细节、淋巴结（LN）状态、mtLNR和生存结局。使用受试者工作特征（ROC）曲线分析确定预测死亡率的mtLNR最佳临界值。采用Kaplan-Meier生存分析估计总生存期（OS）和无病生存期（DFS），并使用对数秩检验评估组间差异。使用Cox比例风险模型计算全因死亡率的风险比（HR）。设定统计学显著性为p<0.05。结果 患者的平均年龄为70.31±11.57岁，男性占65.98%。83.51%的患者进行了低位前切除术（LAR），26.8%的患者进行了腹腔镜手术。整个队列的中位OS为24个月（范围：3 - 60个月）。根据mtLNR将患者分为两组，临界值设定为0.2183。高mtLNR与较差的DFS和OS显著相关（分别为p = 0.021和p = 0.003）。此外，与mtLNR较低的患者相比，mtLNR>0.2183的患者复发率、淋巴管侵犯（LVI）和神经周围侵犯（PNI）率显著更高（均p<0.001）。mtLNR的最佳临界值预测死亡率的特异性为81.4%，敏感性为48.1%（曲线下面积（AUC）为0.662，p = 0.012）。Kaplan-Meier分析显示两组生存存在显著差异；mtLNR>0.2183的患者全因死亡风险高3.71倍（p = 0.002）。结论 mtLNR是直肠癌患者生存和预后的重要决定因素。高mtLNR值与较差的生存结局和更具侵袭性的肿瘤特征相关。研究结果表明，在临床决策过程中应考虑mtLNR。这些结果表明，mtLNR可能是临床决策中有价值的预后工具。
