左半与右半结肠癌检出淋巴结数目界值对比研究  

Minimal Examined Lymph Node Count for Right-and Left-Sided Colon Cancer:a Comparative Study

作　　者：杨悦生 杨梓锋 欧阳凯博 吕泽坚 王俊江[2] 吴德庆[2] 李勇[2] YANG Yue-sheng;YANG Zi-feng;OU-YANG Kai-bo(Clinical Medicine,Shantou University Medical College,Shantou 515041,China;Department of Gastrointestinal Surgery,Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 519041,China;不详)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]南方医科大学附属广东省人民医院(广东省医学科学院)胃肠外科,广东广州519041

出　　处：《中国实用外科杂志》2023年第10期1152-1157,共6页Chinese Journal of Practical Surgery

基　　金：国家临床重点专科建设项目(No.2022YW030009)。

摘　　要：目的分析左半与右半结肠癌检出淋巴结数目与分期偏移、生存之间的关系,确定检出淋巴结数目界值。方法检索并提取美国监测、流行病学和最终结果(SEER)数据库2004—2018年89460例结肠癌病例资料,并以广东省人民医院胃肠外科同期收治的783例结肠癌病人资料作为外部验证数据。比较左半与右半结肠癌病人的临床病理特征、检出淋巴结数目及生存预后。使用局部加权回归拟合概率曲线和Chow检验分别确定检出淋巴结数目界值。结果左半与右半结肠癌检出淋巴结数目、预后差异有统计学意义(P<0.05),检出淋巴结数目是影响分期偏移和生存的独立因素。对于无淋巴结转移的病人,左半结肠癌的检出淋巴结数目界值为14枚,右半结肠癌的检出淋巴结数目界值为11枚。结论右半与左半结肠癌需要采用不同的检出淋巴结数目界值以准确分期,更好地评估生存结果,指导辅助治疗的选择。Objective To investigate the association between optimal examined lymph node(ELN)count,stage migration,and survival in patients with right-and left-sided colon cancer and determine their new ELN values.Methods The study included 89,460 patients with colon cancer from the Surveillance,Epidemiology,and End Results database and 783 patients from a single institution diagnosed from 2004 to 2018.Right colon cancer(RCC)and left colon cancer(LCC)were separated by splenic flexure.After grouping the patients according to tumor location,the clinicopathological features,ELN count,and survival were compared.Locally weighted scatter-plot smoothing and Chow test were used to determine an optimal cutoff value of ELNs.Results The ELNs and prognosis varied between RCC group and LCC group.ELNs were identified as significant independent predictive and prognostic factors for stage migration and survival.The optimal ELN cut-off value for node-negative patients was 14 for left-sided colon cancer and 11 for right-sided colon cancer.Conclusion Right-and left-sided colon cancer may require different ELN counts for accurate staging and better estimation of survival outcomes,which would promote better prognostication and precise guidance of adjuvant therapy.

关 键 词：左半结肠癌 右半结肠癌 检出淋巴结 生存 分期偏移 

分 类 号：R6[医药卫生—外科学]