Lymph node recovery from colorectal tumor specimens: Recommendation for a minimum number of lymph nodes to be examined
Lymph node recovery from colorectal tumor specimens: Recommendation for a minimum number of lymph nodes to be examined
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DOI：
10.1007/s00268-001-0236-8
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发表时间：
2002-03-01
影响因子：
2.6
通讯作者：
Cortesini, C
中科院分区：
文献类型：
--
作者：
Cianchi, F;Palomba, A;Cortesini, C
淋巴结转移是结直肠癌根治术后最重要的预后因素。为了正确评估肿瘤的淋巴结状态，必须对手术标本进行准确的检查。对于肿瘤分类为Dukes B（TNM II期）的患者，分期不足的风险特别高。本研究的目的是确定每个手术标本检查的指定最低淋巴结数量是否会对接受Dukes B结直肠癌根治性手术的患者的预后产生任何影响。在1988年至1995年期间，共有140名患者接受了Dukes B结肠直肠癌根治性切除术，由同一外科医生（C.C.）。使用Kaplan-Meier方法估计临床病理变量与生存率之间的关系。使用考克斯比例风险回归模型来确定可独立影响生存期的变量。每个肿瘤标本平均检查12个淋巴结（范围3-38）。Dukes B期患者术后检查淋巴结不超过8个的5年生存率为54.9%，而检查淋巴结不超过9个的患者的5年生存率为79.9%（p < 0.001）。考克斯回归分析确定淋巴结数量是唯一的独立预后因素（p = 0.01）。70例有1 - 4个转移淋巴结的患者（Dukes C级患者）在同一时期接受了手术，被纳入生存分析进行比较。Dukes B期患者的5年生存率与Dukes C期患者相似（分别为54.9%和51.8%）。在Dukes B结直肠患者中检查8个或更少的淋巴结可能被认为是手术标本中缺失阳性淋巴结的高风险因素。我们的研究结果表明，收获和检查每个手术标本至少9个淋巴结可能是足够的淋巴结阴性肿瘤的可靠分期。
Lymph node involvement is the most important prognostic factor for patients who have undergone radical surgery for colorectal carcinoma. An accurate examination of the surgical specimens is mandatory for the correct assessment of the lymph node status of the tumor. The risk of understaging is particularly high for patients with tumors classified as Dukes B (TNM stage II). The aim of this study was to determine if a specified minimum number of lymph nodes examined per surgical specimen could have any effect on the prognosis of patients who had undergone radical surgery for Dukes B colorectal cancer. Between 1988 and 1995 a total of 140 patients underwent radical resection of Dukes B colorectal cancer by the same surgeon (C.C.). The relation between clinicopathologic variables and survival was estimated using the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify the variables that can independently influence Survival. A median of 12 lymph nodes (range 3-38) was examined per tumor specimen. The 5-year survival rate of Dukes B patients who had had eight or fewer lymph nodes examined after surgery was 54.9%, whereas the survival rate for those who had had nine or more lymph nodes examined was 79.9% (p < 0.001). Cox regression analysis identified the number of lymph nodes as the only independent prognostic factor (p = 0.01). Seventy patients with one to four metastatic lymph nodes (Dukes C patients) who had been operated on during the same period were included in the survival analysis for comparison. The 5-year survival rate of the Dukes B patients with eight or fewer lymph nodes examined was similar to that of the 70 Dukes C patients (54.9% and 51.8%, respectively). Examination of eight or fewer lymph nodes in Dukes B colorectal patients may be considered a high risk factor for missing positive lymph nodes in the surgical specimens. Our results suggest that harvesting and examining a minimum of nine lymph nodes per surgical specimen may be sufficient for reliable staging of lymph node-negative tumors.