对于患有杜克B期（TNM分期II期）结直肠癌的患者，检查六个或更少的淋巴结与预后不良有关。

For patients with Dukes' B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis.

作者信息

Caplin S, Cerottini J P, Bosman F T, Constanda M T, Givel J C

机构信息

Department of Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

出版信息

Cancer. 1998 Aug 15;83(4):666-72.

PMID:9708929

Abstract

BACKGROUND

Lymph node status is pivotal to the staging of colorectal carcinoma. The diagnosis of a lymph node negative tumor should imply a good prognosis; however, the outcomes for Dukes' B (TNM Stage II) patients remain variable, possibly in part due to understaging. The aim of this study was to determine whether examining a specified minimum number of lymph nodes using conventional techniques would eliminate the risk of understaging and thus have an effect on prognosis.

METHODS

Data on patients who underwent surgery for colorectal carcinoma at a single institution between 1985 and 1990 were reviewed. Patients with Dukes' B (TNM Stage II) or C (TNM Stage III) tumors and histologically confirmed disease-free resection margins who were treated with curative intent were included. Correlations among variables were assessed using the chi-square test, and survival comparisons were made using Kaplan-Meier curves and the log rank test. Multivariate analysis was performed using a Cox regression model.

RESULTS

Dukes' B (TNM Stage II) patients with < or =6 lymph nodes examined had significantly poorer overall survival than those with > or =7 lymph nodes examined (P = 0.0014). Such a significant difference was not observed among Dukes' C (TNM Stage III) patients (P = 0.7). Survival of Dukes' C patients was significantly worse compared with that of Dukes' B patients overall and Dukes' B patients with > or =7 lymph nodes examined (P < 0.0001). There was no significant difference in survival between Dukes' C and Dukes' B patients with < or =6 lymph nodes examined (P = 0.02). The number of examined lymph nodes was the only significant parameter correlated with survival in the multivariate analysis (P = 0.002).

CONCLUSIONS

Because Dukes' B patients with < or =6 examined lymph nodes have poorer outcomes than those with a higher number examined (probably due to understaging), the total number of examined lymph nodes should always be reported.

摘要

背景

淋巴结状态对于结直肠癌的分期至关重要。淋巴结阴性肿瘤的诊断应意味着预后良好；然而，Dukes B期（TNM分期II期）患者的预后仍然存在差异，部分原因可能是分期不足。本研究的目的是确定使用传统技术检查特定数量的淋巴结是否会消除分期不足的风险，从而影响预后。

方法

回顾了1985年至1990年间在单一机构接受结直肠癌手术的患者数据。纳入Dukes B期（TNM分期II期）或C期（TNM分期III期）肿瘤、组织学证实切缘无病且接受根治性治疗的患者。使用卡方检验评估变量之间的相关性，使用Kaplan-Meier曲线和对数秩检验进行生存比较。使用Cox回归模型进行多变量分析。

结果

检查淋巴结数≤6个的Dukes B期（TNM分期II期）患者的总生存率明显低于检查淋巴结数≥7个的患者（P = 0.0014）。在Dukes C期（TNM分期III期）患者中未观察到这种显著差异（P = 0.7）。总体而言，Dukes C期患者的生存率明显低于Dukes B期患者以及检查淋巴结数≥7个的Dukes B期患者（P < 0.0001）。检查淋巴结数≤6个的Dukes C期和Dukes B期患者的生存率无显著差异（P = 0.02）。在多变量分析中，检查的淋巴结数量是与生存相关的唯一显著参数（P = 0.002）。