Lymph Node Ratio is Not Predictive of Survival in Stage III Colorectal Cancer with Less than 12 Lymph Nodes Examined

當術中淋巴結摘取數目少於12顆時，轉移淋巴結及淋巴結摘取數目比率在第三期大腸直腸癌病患無法當做預後指標

胡哲銘(Je-Ming Hu) ； 饒樹文(Shu-Wen Jao) ； 蕭正文(Cheng-Wen Hsiao) ； 李家政(Chia-Cheng Lee) ； 陳昭仰(Chao-Yang Chen) ； 張玉樺(Yu-Hua Chang) ； 吳文智(Wen-Chih Wu) ； 張賢鋒(Hsien-Feng Chang) ； 周雨青(Yu-Ching Chou) ； 吳昌杰(Chang-Chieh Wu)

《中華民國大腸直腸外科醫學會雜誌》 28卷2期 (2017/06) Pp. 49-65

https://doi.org/10.6312/SCRSTW.2017.28(2).10511

摘要

Background. Lymph node ratio (LNR) (positive lymph nodes/sampled lymph nodes) is associated with disease-free survival (DFS) and 5-year tumor-specific survival (5-year TSS) in stage III colorectal cancer (CRC). The likelihood of receiving inadequate lymph nodes yield (LNY) (i.e., at least 12 LNs examined), and the influence of accurate predictive factors on LNR evaluation. This study identified predictors of LNR evaluation instage III CRC patients who had different lymph nodes (LNs) sampling status (less than or more than 12 LNs examined). Methods. From January 2000 to December 2014, the follow-up status of stage III CRC patients who underwent surgery in a single medical center was retrospectively analyzed. These patients were stratified into LNR groups 1 (LNR ≤ 0.1), LNR groups 2 (0.1 ＜ LNR ≤ 0.2), and LNR groups 3 (0.2 ＜ LNR ≤ 0.42), and LNR groups 4 (LNR ＞ 0.42). Prognostic significance with DFS, and 5-year TSS curves were calculated with the Kaplan- Meier survival analysis and Cox proportional hazards regression. Results. In the study population, including 656 stage III CRC patients with a mean age of 67.06 ± 14.18 years. Of the 656 patients, an adequate number of lymph nodes (n ≥ 12) had been harvested in 495 patients. Right-sided tumor, higher T stage, higher N status and poor differentiated were all associated with higher LNR. Amultivariate analysis showed that lower LNR was associated with better DFS when more than 12 LNs were sampling status in stage III CRC patients. However, LNR was not an accurate prognostic factor for DFS and 5-year TSS when fewer than 12 LNs were sampling status in stage III CRC patients. Conclusions. These results support consideration that lymph node ratio isn't predictive of survival in stage III CRC with less than 12 LNs examined.

關鍵字

Stage III colorectal cancer (CRC) ； Lymph nodes yield (LNY) ； 5-year tumor-specific survival (TSS)

並列摘要

目的 轉移淋巴結數目及淋巴結摘取數目比率，目前被認為與第三期大腸直腸癌的無疾病存活期與五年存活率有關係。然淋巴結摘取數目大於12 顆已被國際視為治療大腸癌病患品質的指標之一。本研究的目的在於評估轉移淋巴結數目及淋巴結摘取數目比率對第三期大腸直腸結腸癌病患預後的預測價值，是否有受淋巴結摘取數目有無大於12 顆影響。方法 從2000 年1 月至2014 年12 月間，第三期大腸直腸癌在本院接受根治性手術。第三期病患依淋巴結摘取數目 (≥ 12 或 ＜ 12) 及依轉移淋巴結目與淋巴結摘取數目比率(LNR ≤ 0.1; 0.1 ＜ LNR ≤ 0.2; 0.2 ＜ LNR ≤ 0.42; LNR ＞ 0.42) 進行存活影響分析。結果 在本實驗中，共656 病患第三期大腸直腸癌病患收案，平均年齡67.06 ± 14.18 歲。術中淋巴結摘取數目大於12 顆的人數有495 位。右側大腸、侵略性T 及N 分期、低度分化與轉移淋巴結數目及淋巴結摘取數目高比率有關係。在多變數分析中，當術中淋巴結摘取數目 ≥ 12 時，轉移淋巴結數目及淋巴結摘取數目低比率的第三期大腸直腸癌病患，有較好無疾病存活期。然而，術中淋巴結摘取數目 ＜ 12 時，轉移淋巴結數目及淋巴結摘取數目比率，與第三期大腸直腸癌的無疾病存活期與五年存活率預測，無統計學上意義。結論 術中淋巴結摘取數目 ＜ 12 顆時，轉移淋巴結數目及淋巴結摘取數目比率，無法對第三期大腸直腸癌預後，提供精準的預測。

並列關鍵字

轉移淋巴結數目及淋巴結摘取數目 ； 無疾病存活期 ； 存活率 ； 第三期大腸直腸癌腸

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