Ⅲ期直肠癌根治术淋巴结清扫总数及阴性淋巴结数与预后的关系  

The correlation of total lymph nodes dissected and that of negative lymph nodes to the prognosis ofpatients with stage 11I rectal carcinoma undergoing radical resection

作　　者：孙国瑞[1] 徐阳[1] 曲辉[1] 周鹏[1] 彭景伟[1] 何庆泗[1] 

机构地区：[1]山东大学齐鲁医院普外一科,济南250012

出　　处：《中华普通外科杂志》2012年第12期974-977,共4页Chinese Journal of General Surgery

摘　　要：目的探讨Ⅲ期直肠癌根治术后淋巴结清扫总数及阴性淋巴结数与预后的关系。方法回顾性分析山东大学齐鲁医院2002－2007年412例Ⅲ期直肠癌根治术患者的临床资料。依淋巴结清扫总数及阴性淋巴结数分为5组，分别为1～6枚组、7～12枚组、13～18枚组、19～24枚组和〉24枚组，用Kaplan-Meier法计算生存率，生存率的组间比较采用Log-rank检验并做趋势检验。应用Pearson相关分析法分析淋巴结清扫总数与阴性淋巴结数的相关性。多因素分析采用Cox比例风险模型分析。结果患者1、3、5年生存率分别为79．9％，59．2％，43．0％。患者术后5年生存率随淋巴结清扫总数及阴性淋巴结数目的增加而升高（20．0％、26．5％、43．9％、54．2％、53．5％，P=0．001；10．3％、34．8％、51．9％、56．8％、70．8％，P=0．000）。412例患者共清扫淋巴结7301枚，阴性淋巴结5698枚，淋巴结清扫总数及阴性淋巴结数具有明显相关性（r=0．899，P=0．000）。淋巴结清扫总数及阴性淋巴结数为独立预后因素。结论在Ⅲ期直肠癌根治术中，淋巴结清扫总数及阴性淋巴结数与预后明显相关，在规范化进行根治性手术的前提下，可将淋巴结清扫总数及阴性淋巴结数作为判断预后的辅助指标。Objective To study retrospectively the relation of the number of all dissected and negative lymph nodes （ LNs ） to the prognosis of patients with stage Ⅲ rectal carcinoma after radical resection. Methods From 2002 to 2007, 412 sage Ⅲ rectal carcinoma patients undergoing radical resection were enrolled. Patients were divided into five groups according to the number of dissected LNs as follows： 1 to 6 lymph nodes, 7 to 12 lymph nodes, 13 to 18 lymph nodes, 19 to 24 lymph nodes, and more than 24 lymph nodes. The association with the survival was analyzed. The Kaplan-Meier method was used to estimate survival as a function of time, and survival differences were analyzed with the log-rank test. The correlation between all dissected and negative lymph nodes was analyzed. The Cox proportional hazard model were used to investigate the risk factors for stage Ⅲ rectal carcinoma. Results The 1, 3 and 5 years survival rates were respectively 79.9% ,59. 2% and 43.0%. The 5-year survival rates increased with the increasing number of the examined LNs and the negative LNs, the differences were significant （20. 0%, 26. 5% ,43.9%, 54. 2%, 53.5%, P = 0. 001 ; 10. 3%, 34. 8%, 51.9%, 56. 8%, 70. 8%, P = 0. 000 ）. There were 7301 LNs dissected among which 5698 were pathology negative. The dissected LNs were correlated positively with negative LNs on the Pearson＇s correlation test（ correlation coefficients r = 0. 899）. The total number of dissected LNs and negative LNs were independent prognostic predictors. Conclusions The total number of dissected lymph node and negative lymph nodes are significantly correlated to prognosis of staged 19 rectal carcinoma patient. On premise of standard procedure, we see all dissected and negative lymph nodes as a prognostic auxiliary index.

关 键 词：直肠肿瘤 淋巴结切除术 预后 

分 类 号：R735.37[医药卫生—肿瘤]