淋巴结数量指标在N1c期结直肠癌患者预后中的价值  

The prognostic impact of number-indexes of lymph nodes in stage N1c colorectal cancer patients

作　　者：奚克兴 宋诗瑜 罗振恺 孙志刚 冯林 张海增 Xi Kexing;Song Shiyu;Luo Zhenkai;Sun Zhigang;Feng Lin;Zhang Haizeng(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;State Key Laboratory of Molecular Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院分子肿瘤学国家重点实验室,北京100021

出　　处：《中华医学杂志》2022年第19期1423-1429,共7页National Medical Journal of China

基　　金：国家自然科学基金(81972317);中国医学科学院医学与健康科技创新工程(2021-I2M-1-021, 2021-I2M-C&T-A-013)。

摘　　要：目的探讨淋巴结数量指标在N1c期结直肠癌患者预后中的价值。方法回顾性分析2010年1月至2015年12月在中国医学科学院肿瘤医院, 以及美国监测、流行病学和最终结果(SEER)数据库中初治且行根治性手术的pTxN1cM0期结直肠癌患者的临床病理资料, 纳入N1c期患者1 165例, 其中中国医学科学院肿瘤医院85例[男54例, 女31例;中位年龄58(范围:32~80)岁];SEER数据库1 080例[男566例, 女514例;中位年龄66(范围:24~98)岁]。探讨淋巴结总数或阴性淋巴结数、阳性淋巴结对数比(LODDS)在N1c期结直肠癌患者中的预后价值。结果淋巴结总数或阴性淋巴结数的最佳截断值为13枚, LODDS的最佳截断值为-1.43。在85例中国医学科学院肿瘤医院病例中, N1c1期(淋巴结总数或阴性淋巴结数≥13枚, 69例)和LODDS1组(LODDS≤-1.43, 69例)患者的5年生存率均为80.9%, 均高于N1c2期(淋巴结总数或阴性淋巴结数<13枚, 16例)和LODDS2组(LODDS>-1.43, 16例)患者(均为53.3%, 均P=0.002)。在1 080例SEER数据库病例中, N1c1期(837例)和LODDS1组(LODDS≤-1.43, 837例)患者的5年生存率均为64.7%, 均高于N1c2期(243例)和LODDS2组(LODDS>-1.43, 243例)患者(均为52.2%, 均P<0.001)。Cox多因素风险回归模型分析结果显示, 无论在中国医学科学院肿瘤医院病例, 还是SEER数据库病例中, 淋巴结总数或阴性淋巴结数<13枚均是影响N1c期结直肠癌患者总生存时间的危险因素, HR(95%CI)分别为3.794(1.539~9.349)、1.588(1.232~2.048);而LODDS≤-1.43均是影响N1c期结直肠癌患者的总生存时间的保护因素, HR(95%CI)分别为0.264(0.107~0.650)、0.630(0.488~0.812)。结论淋巴结总数或阴性淋巴结数和LODDS是N1c期结直肠癌患者预后的影响因素, 临床上对N1c期结直肠癌患者应该按淋巴结总数或阴性淋巴结数和LODDS进行预后分层, 并制定不同的辅助治疗方案。Objective To evaluate the impact of number-indexes of lymph nodes for prognostic stratification in stage N1c colorectal cancer(CRC)patients.Methods The clinicopathologic data of CRC patients with stage pTxN1cM0 who initially underwent radical surgery in Cancer Hospital,Chinese Academy of Medical Sciences and the Surveillance,Epidemiology and End Results(SEER)database from January 2010 to December 2015 were retrospectively analyzed.A total of 1165 patients with stage N1c were included in this study.Among them,85 patients(including 54 males and 31 females)were from Cancer Hospital,Chinese Academy of Medical Sciences and their median age was 58(range:32-80)years;1080 patients(including 566 males and 514 females)were from the SEER database and their median age was 66(range:24-98)years.The prognostic significance of total number of lymph node(TLN),number of negative lymph node(NLN),and log odds of positive lymph nodes(LODDS)in stage N1c CRC patients were explored.Results The optimal cut-off value of TLN or NLN was 13,and the optimal cut-off value of LODDS was-1.43.Among the 85 patients of Cancer Hospital,Chinese Academy of Medical Sciences,the 5-year overall survival(OS)rates of stage N1c1(TLN or NLN≥13,69 cases)and group LODDS1 patients(LODDS≤-1.43,69 cases)were both 80.9%,which higher than that of stage N1c2(TLN or NLN<13,16 cases)and group LODDS2(LODDS>-1.43,16 cases)patients(both 53.3%,P=0.002);In the SEER cohort,the 5-year OS rates of stage N1c1(837 cases)and group LODDS1 patients(LODDS≤-1.43,837 cases)were both 64.7%,which higher than that of stage N1c2(243 cases)and group LODDS2(LODDS>-1.43,243 cases)patients(both 52.2%,P<0.001).Both in the NCC cohort and SEER cohort,the results of Cox multivariate analysis all demonstrated that TLN or NLN<13 was the risk factor of OS of CRC patients with stage N1c(HR=3.794,95%CI:1.539-9.349,P=0.004;and HR=1.588,95%CI:1.232-2.048,P<0.001;respectively);LODDS≤-1.43 was the independent protective factor of OS of stage N1c CRC patients(HR=0.264,95%CI:0.107-0.650;and HR=0.63

关 键 词：结直肠肿瘤 预后 淋巴结总数 阴性淋巴结数 阳性淋巴结对数比 回顾性队列研究 

分 类 号：R735.34[医药卫生—肿瘤]