淋巴结转移率对结直肠癌患者预后评估的价值  

Prognostic significance of metastatic lymph node ratio in colorectal cancer

作　　者：赵阳[1] 李德川[1] 楼荣灿[1] 陈伟平[1] 陈贵平[1] 范永田[1] 

机构地区：[1]浙江省肿瘤医院大肠外科,杭州310022

出　　处：《中华肿瘤杂志》2009年第10期764-768,共5页Chinese Journal of Oncology

摘　　要：目的探讨淋巴结转移率（MLR）在结直肠癌患者预后评估中的临床应用价值。方法回顾303例手术治疗的结直肠癌患者的临床资料，分析MLR和淋巴结转移数目与清扫淋巴结总数的相关性，以及影响结直肠癌患者预后的因素，探讨MLR预测结直肠癌患者术后5年生存情况的准确性，并与淋巴结转移数目的预测结果进行比较。结果MLR与清扫淋巴结总数无相关性（r=-0．099，P〉0．05），而淋巴结转移数目与清扫淋巴结总数有相关性（r=0．107，P〈0．05）。Kaplan-Meier生存分析显示，即使受检淋巴结总数〈12枚，MLR仍影响患者术后生存时间（χ^2=42．878，P〈0．01）。rN0、rN1、rN2和rN3期患者的5年生存率分别为90．9％、68．9％、54．7％和39．4％，差异有统计学意义（P〈0．01）。多因素分析显示，肿瘤大小和rN分期是影响结直肠癌患者预后的独立危险因素。通过比较相对危险度，独立危险因素与预后的密切程度依次为rN分期〉肿瘤大小。MLR和淋巴结转移数目预测结直肠癌患者术后5年生存的ROC曲线下面积比较，差异无统计学意义。结论结直肠癌患者的MLR与清扫淋巴结总数不相关；MLR是结直肠癌患者预后的主要独立危险因素；MLR预测结直肠癌患者术后5年生存情况的准确性与淋巴结转移数目的预测能力相同。Objective To investigate the prognostic significance of metastatic lymph node ratio in patients with colorectal cancer. Methods The clinicopathological data of 303 surgically treated patients with colorectal cancer were retrospectively analyzed. Spearman correlation analysis was used to determine the correlation coefficient. The survival was analyzed using Kaplan-Meier method, and the survival difference was assessed by Log-rank test. Multivariate analysis was performed using Cox proportional hazard regression model in forward stepwise regression. Receiver working characteristic curve was used to compare the accuracy of the metastatic lymph nodes ratio in predicting the death of patients at 5 years postoperatively with that of the number of metastatic lymph nodes. Results The MLR was not correlated with the total number of dissected lymph nodes （ Spearman correlation coefficient ： - 0. 099, P 〉 0.05 ）, but the positive rate of metastatic lymph nodes did （ correlation coefficient ： 0. 107, P 〈 0.05 ）. Kaplan-Meier survival analysis revealed that the MLR significantly influenced the postoperative survival time （ Log-rank χ^2 = 42. 878, P 〈 0.01 ）, even in the patients with less than 12 resected lymph nodes. The 5-year survival rates for rN0, rN1, rN2 and rN3 were 90.9%, 68.9%, 54.7% and 39.4%, respectively. There was a significant difference between the different stages （P 〈0.01 ）. Cox proportional hazard regression model analysis showed that the metastatic lymph node ratio was an independent prognostic factor. （EXP（B） = 7. 809, P 〈 0.01 ）. There was no significant difference between metastatic lymph node ratio and the number of metastatic lymph nodes in predicting the death of patients at 5 years postoperatively based on the area under the receiver working characteristic curve. Conclusion The metastatic lymph node ratio in colorectal cancer patients is not correlated with the total number of dissected lymph nodes. The metastatic lymph node ratio is a major independent prognos

关 键 词：结直肠肿瘤 淋巴结转移 肿瘤分期 预后 

分 类 号：R686[医药卫生—骨科学]