Hida J, Mori N, Kubo R, Matsuda T, Morikawa E, Kitaoka M, Sindoh K, Yasutomi M
First Department of Surgery, Kinki University School of Medicine, Osaka, Japan.
J Am Coll Surg. 1994 Mar;178(3):223-8.
A study of regional lymph node metastases was performed using the clearing method in 322 patients with carcinoma of the colon and rectum (140 with carcinoma of the colon and 182 with carcinoma of the rectum) who had undergone surgical resection. The mean number of nodes examined per patient was 76.4 and the metastatic rate (patients with metastases divided by the total of patients) was 61.4 percent, with a metastatic incidence (nodes with metastases divided by the total of examined nodes) of 6.4 percent for carcinoma of the colon using the clearing method. For carcinoma of the rectum, the mean number of nodes examined was 73.7 with a metastatic rate of 57.1 percent and a metastatic incidence of 7.1 percent. In contrast, node analysis by the conventional manual method resulted in a mean of 18.1 nodes being examined, with a metastatic rate and incidence of 42.1 and 12.8 percent, respectively, for carcinoma of the colon. Manual examination of lymph nodes in carcinoma of the rectum resulted in a mean of 21.2 nodes being examined, with a metastatic rate and incidence of 50.0 and 16.8 percent, respectively. Compared with the manual method, the clearing method provided a greater number of nodes, a higher metastatic rate and a lower metastatic incidence. These differences may be explained by the detection of metastatic regional nodes smaller than 4 millimeters in maximum diameter by the clearing method. By TNM classification there were more pN3 than pN2 lesions. The five year survival rate after curative resection was 78.5 percent for pN1 lesions, 45.7 percent for pN2 lesions and 45.4 percent for pN3 lesions for carcinoma of the colon and 72.7 percent for pN1 lesions, 75.0 percent for pN2 and 53.9 percent for pN3 lesions for carcinoma of the rectum. There was no significant survival difference between the patients with pN1, pN2 and pN3 carcinomas. The presence of regional nodes metastases should be examined in detail. Therapies and prognosis of carcinoma of the colon and rectum should be discussed based on accurate staging.
对322例行手术切除的结肠癌和直肠癌患者（140例结肠癌患者和182例直肠癌患者）采用清除法进行区域淋巴结转移研究。每位患者检查的淋巴结平均数量为76.4个，转移率（发生转移的患者数除以患者总数）为61.4%，采用清除法时结肠癌的转移发生率（有转移的淋巴结数除以检查的淋巴结总数）为6.4%。对于直肠癌，检查的淋巴结平均数量为73.7个，转移率为57.1%，转移发生率为7.1%。相比之下，采用传统手工方法进行淋巴结分析时，结肠癌患者平均检查18.1个淋巴结，转移率和转移发生率分别为42.1%和12.8%。直肠癌患者手工检查淋巴结时，平均检查21.2个淋巴结，转移率和转移发生率分别为50.0%和16.8%。与手工方法相比，清除法检查的淋巴结数量更多，转移率更高，转移发生率更低。这些差异可能是由于清除法能检测到最大直径小于4毫米的区域转移淋巴结。根据TNM分类，pN3病变比pN2病变更多。结肠癌pN1病变根治性切除后的五年生存率为78.5%，pN2病变为45.7%，pN3病变为45.4%；直肠癌pN1病变为72.7%，pN2病变为75.0%，pN3病变为53.9%。pN1、pN2和pN3期癌患者之间的生存率无显著差异。应详细检查区域淋巴结转移情况。应基于准确分期讨论结肠癌和直肠癌的治疗及预后。
