The Impact of Lymph Node Harvest and Lymph Node Ratio on Survival in Stage I-III Colon Cancer

淋巴結摘取數目及轉移淋巴結比率對第一至三期結腸惡性腫瘤病患的影響

李讚紘(Tsan-Hung Lee) ； 靳志堅(Chih-Chien Chin) ； 郭益宏(Yi-Hung Kuo) ； 黃文詩(Wen-Shih Huang) ； 陳進勛(Jinn-Shiun Chen)

《中華民國大腸直腸外科醫學會雜誌》 25卷3期 (2014/09) Pp. 74-84

https://doi.org/10.6312/SCRSTW.2014.25(3).10307

摘要

目的　淋巴結摘取數目≥ 12已被衛生署國民健康局視為治療大腸癌病患品質的指標之一。然而在第一期患者，臨床上淋巴結摘取數目經常無法達到標準，本研究的目的在於評估淋巴結摘取數目及轉移淋巴結比率對第一至三期結腸惡性腫瘤病患的存活影響。方法　從1995年1月至2004年12月間，共3564病患因第一至第三期結腸癌接受根治性手術。第一至三期病患依淋巴結摘取數目（≥ 12或＜ 12）及第三期病患依轉移淋巴結比率（＜ 0.4, 0.4至0.7，及≥ 0.7）進行存活影響分析。結果　第二及第三期患者的平均淋巴結摘取數目與第一期患者（平均為17.6，範圍1至96）比較，差異為8.0與8.1（p ＜ 0.001）。在多變數分析中，TNM分期與腫瘤位置是影響淋巴結摘取數目是否≥ 12的獨立因子（p ＜ 0.001）。在單變數分析中，淋巴結摘取數目≥ 12對第二期與第三期結腸癌患者的5年存活率具有決定性的影響（p = 0.001與p = 0.009）；淋巴結摘取數目≥ 12與否對第一期病患則不具影響力（p = 0.653）。在多變數分析中，淋巴結摘取數目對第三期結腸癌患者5年存活率的影響則被轉移淋巴結比率所取代（p ＜ 0.001）。結論　淋巴結摘取數目≥ 12對5年存活率的影響在不同期別的結腸癌有不同的影響力。在第三期結腸癌患者，轉移淋巴結比率比淋巴結摘取數目更具有決定性的影響。

關鍵字

淋巴結摘取 ； 淋巴轉移比率 ； 存活率 ； 第一至第三期結腸惡性腫瘤

並列摘要

Purpose. Lymph node harvest (LNH) ≥12 has been endorsed as a quality measure for patient care by the Bureau of Health Promotion, Department of Health, R.O.C. The aim of this study is to evaluate the impact of LNH and node-positive ratio (LNR) on overall survival in stage I-III colon cancer because an inadequate harvest is common in stage I disease. Methods. From January 1995 to December 2004, a total of 3564 stage I-III colon cancer patients who underwent curative surgery were identified. All patients were classified according to LNH as either adequate (≥ 12) or inadequate (＜ 12). The stage III cancer patients were categorized into 3 groups, LNR1 to 3, according to interval: ＜ 0.4, 0.4 to 0.7, and ＞ 0.7. Results. The mean of LNH in the stage I group was 17.6 (1 to 96). When compared to stage II and III, the node harvest differences were -8.0 and -8.1, respectively (p ＜ 0.001). In multivariate analysis, the TNM-stage and tumor location were the independent factors affecting LNH (p ＜ 0.001). In univariate analysis, the LNH played a crucial role for 5-year overall survival (OS) in stage II (p = 0.001) and III disease (p = 0.009), but not in stage I (p = 0.653). In multivariate analysis, the LNH was replaced by LNR as an independent predictor in stage III colon cancer (p ＜ 0.001). Conclusion. The impact of LNH on survival was different in different stages of colon cancer. LNR was more crucial than LNH with regard to survival in stage III disease.

並列關鍵字

Lymph node harvest ； Lymph node ratio ； Survival ； Stage I-III colon cancer

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