Maurel J, Launoy G, Grosclaude P, Gignoux M, Arveux P, Mathieu-Daudé H, Raverdy N, Faivre J
Service de Chirurgie Digestive-CHU Caen et Registre des Tumeurs Digestives du Calvados, CJF INSERM, France.
Cancer. 1998 Apr 15;82(8):1482-6.
In patients with resected colorectal carcinoma, lymph node involvement has particular importance for patient prognosis and adjuvant therapy. The network of French cancer registries (FRANCIM) established a study aimed at analyzing the validity of lymph node harvest reporting in a population-based sample.
The study population was comprised of 1081 resected tumors without distant visceral metastasis and classified using the TNM system. Correlation between the number of examined lymph nodes and the staging of the tumor was examined by logistic regression analysis to establish an estimate of the minimum number of lymph nodes required to determine whether a tumor is lymph node negative.
An average of 7.7 +/- 0.2 lymph nodes were examined per specimen in the 851 patients for whom the number of lymph nodes examined was known. The proportion of cases classified as N+ increased significantly with the number of examined lymph nodes (chi-square trend = 24.6; P < 0.0001). If the probability of correct lymph node status assessment is 1 in the reference group (comprised of pathology reports of specimens with > or = 16 examined lymph nodes), the probability of correct N+/N- dichotomization was significantly < 1 for the 1 to 3 lymph nodes group and the 4 to 7 lymph nodes group (i.e., 53.7% of cases).
To comply with current rules for adjuvant chemotherapy, surgeons must provide pathologists with at least eight lymph nodes for optimal N+/N- dichotomization to reduce the risk of misclassification and understaging.
在接受结直肠癌切除手术的患者中，淋巴结受累情况对患者预后及辅助治疗尤为重要。法国癌症登记网络（FRANCIM）开展了一项研究，旨在分析基于人群样本的淋巴结清扫报告的有效性。
研究人群包括1081例无远处内脏转移的切除肿瘤，并采用TNM系统进行分类。通过逻辑回归分析检查所检查淋巴结数量与肿瘤分期之间的相关性，以确定判断肿瘤是否为淋巴结阴性所需的最少淋巴结数量。
在已知所检查淋巴结数量的851例患者中，每个标本平均检查7.7±0.2个淋巴结。分类为N+的病例比例随着所检查淋巴结数量的增加而显著增加（卡方趋势=24.6；P<0.0001）。如果在参考组（由检查淋巴结≥16个的标本病理报告组成）中正确评估淋巴结状态的概率为1，那么对于1至3个淋巴结组和4至7个淋巴结组，正确进行N+/N-二分法分类的概率显著<1（即53.7%的病例）。
为符合当前辅助化疗的规则，外科医生必须为病理学家提供至少8个淋巴结，以实现最佳的N+/N-二分法分类，降低错误分类和分期不足的风险。
