Lymph Node Retrieval in Rectal Cancer is Dependent on Many Factors-the Role of the Tumor, the Patient, the Surgeon, the Radiotherapist, and the Pathologist
Lymph Node Retrieval in Rectal Cancer is Dependent on Many Factors-the Role of the Tumor, the Patient, the Surgeon, the Radiotherapist, and the Pathologist
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DOI：
10.1097/pas.0b013e3181b2e01f
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发表时间：
2009-10-01
影响因子：
5.6
通讯作者：
Nagtegaal, Iris D.
中科院分区：
文献类型：
--
作者：
Mekenkamp, Leonie J. M.;van Krieken, Johan H. J. M.;Nagtegaal, Iris D.
淋巴结状态是结直肠癌生存率最强的预后因素。有几个关于需要检查的淋巴结的最小数量的指南，以使可靠的分期成为可能，但在现有的文献中没有达成共识。在这项研究中，我们确定了直肠癌患者中与淋巴结发现数量和淋巴结转移存在相关的因素。此外，检查的淋巴结数量与预后相关。共1227例患者入选多中心前瞻性随机试验，研究新辅助放疗的价值。所有患者中检查的淋巴结的中位数为7.0。有淋巴结转移者的淋巴结获数明显高于无淋巴结转移者。新辅助放疗后，淋巴结转移较少（6.9 vs. 8.5; P < 0.0001）。病理学实验室和病理学家之间的淋巴结产率差异显著。以下患者和肿瘤特征与显著较低的淋巴结回收率相关：年龄超过60岁、超重、体积小、肿瘤浸润深度低、分化程度差和无淋巴反应。淋巴结阴性的患者中，7个或更少的淋巴结检查隐藏的无复发间隔低于患者中，至少有8个淋巴结检查（17.0%比10.7%，P = 0.016）。我们的结论是，在病理实验室的中位数至少8淋巴结需要检查直肠癌标本，但更高的数字是可取的，在大多数情况下，即使在术前放疗后实现。
Lymph node status is the strongest prognostic factor for Survival in colorectal cancer. There are several guidelines concerning the minimum numbers of lymph nodes that need to be examined to make reliable staging possible, but there is no consensus in the available literature. In this study, we determine in patients with rectal cancer factors that relate to the number of lymph nodes found and the presence of lymph node metastasis. In addition, the number of examined lymph nodes was correlated with prognosis. A total of 1227 patients were selected from it Multicenter prospective randomized trial investigating the value of neoadjuvant radiotherapy. The median number of examined lymph nodes in all patients was 7.0. The number of retrieved lymph nodes in patients with node metastasis was significantly higher than in node negative patients. After neoadjuvant radiotherapy fewer lymph nodes were retrieved (6.9 vs. 8.5; P < 0.0001). Variations in lymph node yield between pathology laboratories and individual pathologists were striking. The following patient and tumor characteristics are associated with a significant lower lymph node retrieval: age over 60 years, overweight, small size, and low invasion depth of the tumor, poor differentiation grade, and absence of a lymphoid reaction. Node negative patients in whom seven or less lymph nodes were examined hid a lower recurrence free interval than patients in whom at least 8 lymph nodes were examined (17.0% vs. 10.7%, P = 0.016). We conclude that in pathology laboratories a median of at least 8 lymph nodes need to be examined in rectal cancer specimens, but that higher numbers are desirable and achievable in most cases, even after preoperative radiotherapy.