Shiraishi Toshio, Tominaga Tetsuro, Nonaka Takashi, Takamura Yuma, Oishi Kaido, Hashimoto Shintaro, Noda Keisuke, Ono Rika, Hisanaga Makoto, Fukuda Akiko, Moriyama Masaaki, Uchida Fumitake, Motoyama Kazuki, Kunizaki Masaki, Matsumoto Keitaro
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Surgery, Sasebo City General Hospital, 9-3 Hirase, Sasebo, Nagasaki, 857-8511, Japan.
Surg Today. 2025 May 15. doi: 10.1007/s00595-025-03064-4.
PURPOSE: This study investigated the relationship between log odds of positive lymph nodes (LODDS) and the long-term prognosis in pathological stage 3 obstructive colorectal cancer (CRC) patients who underwent self-expandable metal stent (SEMS) insertion as a bridge to surgery (BTS). METHODS: This retrospective multicenter study included 75 patients with stage 3 CRC. The patients were classified into high-LODDS (LODDS-H, n = 32) and low-LODDS (LODDS-L, n = 43) groups. RESULTS: Significant differences were found in the 5-year relapse-free survival (RFS) rates (LODDS-H: 34.0% vs. LODDS-L: 53.1%; p = 0.041) and overall survival (OS) rates (52.4% vs. 68.3%; p = 0.012). A multivariate analysis revealed that blood loss [hazard ratio (HR) 2.266, 95% confidence interval (CI), 1.142-4.494; p = 0.019] was an independent predictor of the RFS. Age ≥ 75 years old (HR 2.769, 95% CI 1.206-6.360; p = 0.016), blood loss (HR 3.552, 95% CI 1.460-8.643; p = 0.005), adjuvant chemotherapy (HR 0.415, 95% CI 0.177-0.972; p = 0.043), and LODDS (HR 3.593, 95% CI 1.511-8.544; p = 0.004) were independent predictors of OS. CONCLUSIONS: The LODDS appears to be prognostically accurate for patients with stage 3 obstructive CRC undergoing BTS. Incorporating the LODDS into clinical evaluations may enable more accurate prognostic stratification.
目的：本研究调查了接受自膨式金属支架（SEMS）置入作为手术桥梁（BTS）的病理3期梗阻性结直肠癌（CRC）患者的阳性淋巴结对数比值（LODDS）与长期预后之间的关系。 方法：这项回顾性多中心研究纳入了75例3期CRC患者。患者被分为高LODDS组（LODDS-H，n = 32）和低LODDS组（LODDS-L，n = 43）。 结果：5年无复发生存率（RFS）（LODDS-H：34.0% 对 LODDS-L：53.1%；p = 0.041）和总生存率（OS）（52.4% 对 68.3%；p = 0.012）存在显著差异。多因素分析显示，失血 [风险比（HR）2.266，95% 置信区间（CI），1.142 - 4.494；p = 0.019] 是RFS的独立预测因素。年龄≥75岁（HR 2.769，95% CI 1.206 - 6.360；p = 0.016）、失血（HR 3.552，95% CI 1.460 - 8.643；p = 0.005）、辅助化疗（HR 0.415，95% CI 0.177 - 0.972；p = 0.043）和LODDS（HR 3.593，95% CI 1.511 - 8.544；p = 0.004）是OS的独立预测因素。 结论：对于接受BTS的3期梗阻性CRC患者，LODDS在预后评估方面似乎是准确的。将LODDS纳入临床评估可能会实现更准确的预后分层。
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