探索阳性淋巴结比率在ypⅢ期结直肠癌患者中的预后价值及预测模型的建立  

Exploring the prognostic value of positive lymph node ratio in stageⅢcolorectal cancer patients and establishing a predictive model

作　　者：伍雯 张若昕 翁俊勇 马延磊 蔡国响 李心翔 杨永志 WU Wen;ZHANG Ruoxin;WENG Junyong;MA Yanlei;CAI Guoxiang;LI Xinxiang;YANG Yongzhi(Department of Colorectal Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院大肠外科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2024年第9期873-880,共8页China Oncology

基　　金：国家自然科学基金面上项目(82272976);复旦大学“卓越2025”卓学优秀人才项目。

摘　　要：背景与目的:当前,对于中低位局部晚期直肠癌和T4bM0的潜在可切除结肠癌患者,指南均推荐新辅助治疗策略,以提高治疗的缓解率和增加转化性切除的可能性。其中对于ypⅢ期的结直肠癌(colorectal cancer,CRC)患者,均使用国际抗癌联盟(Union for International Cancer Control,UICC)/美国癌症联合会(American Joint Committee on Cancer,AJCC)TNM分期系统评估术后病理学特征。然而,新辅助治疗会导致术区淋巴结退缩,检出淋巴结数不足12枚的患者无法按照常规的TNM分期进行划分,因此TNM分期常无法预测接受过新辅助治疗的ypⅢ期患者的预后。本研究旨在评估阳性淋巴结比率(positive lymph node ratio,LNR)在接受新辅助治疗的ypⅢ期CRC患者中的预后价值。方法:回顾性分析2008—2018年在复旦大学附属肿瘤医院接受新辅助治疗且行根治性手术的ypⅢ期CRC患者。收集患者手术时的年龄、性别、原发肿瘤位置、肿瘤分化等级、病理学分期以及随访期间患者是否复发或死亡等临床病理学特征。纳入标准:接受新辅助治疗和手术且术后病理学检查证实为Ⅲ期的CRC患者。排除标准:①术前影像学检查或术中探查发现已有远处脏器转移;②有既往恶性肿瘤病史;③多原发性CRC。本研究通过复旦大学附属肿瘤医院医学伦理委员会批准(伦理编号:050432-4-2108*)。使用R软件的survminer包(surv_cutpoint算法)计算LNR相对于无病生存期(disease-free survival,DFS)的最佳临界值并依此将患者分为低LNR组和高LNR组,比较两组的临床病理学特征和DFS。采用COX比例风险回归模型筛选不良病理学特征并使用survival包和rms包绘制DFS列线图预测模型。结果:共纳入489例患者,男性289例,女性200例,中位年龄为56岁(23~80岁),中位随访时间为1062 d。随访期间,164例(33.5%)患者死亡。整个队列中,204例(41.7%)患者检出淋巴结数不足12枚。LNR的最佳临界值为0.29,317例患�Background and purpose:Currently,for patients with mid-to-low locally advanced rectal cancer and potentially resectable T4bM0 colon cancer,guidelines recommend neoadjuvant therapy strategies to enhance the response rate and increase the likelihood of conversion surgery.Among these patients,ypⅢstage colorectal cancer(CRC)is assessed using the Union for International Cancer Control(UICC)/American Joint Committee on Cancer(AJCC)TNM staging system for postoperative pathological features.However,neoadjuvant therapy can lead to lymph node regression in the surgical area,resulting in an insufficient number of detected lymph nodes(less than 12),preventing classification according to conventional TNM staging.Thus,TNM staging often fails to predict the prognosis of ypⅢpatients who have undergone neoadjuvant therapy.This study aimed to evaluate the prognostic value of the positive lymph node ratio(LNR)in ypⅢstage CRC patients treated with neoadjuvant therapy.Methods:Retrospective data was collected from ypⅢstage CRC patients who received neoadjuvant therapy and underwent radical surgery at Fudan University Shanghai Cancer Center between 2008 and 2018.Collect clinical pathological characteristics such as age,gender,primary tumor location,tumor differentiation grade,pathological staging,and whether the patient has relapsed or died during follow-up at the time of surgery.Inclusion criteria:CRC patients who have received neoadjuvant therapy and surgery and have been confirmed to be stageⅢby postoperative pathological examination.Exclusion criteria:①Preoperative imaging examination or intraoperative exploration reveals distant organ metastasis;②History of malignant tumors in the past;③Multiple primary CRC.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:050432-4-2108*).The R software survminer package(surv_cutpoint algorithm)was used to calculate the optimal cutoff value for LNR relative to disease-free survival(DFS),and patients were divided into lo

关 键 词：结直肠癌 新辅助治疗 阳性淋巴结比率 预后 预测模型 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]