The Prognostic Value of Lymph Node Ratio in a Population-Based Collective of Colorectal Cancer Patients
The Prognostic Value of Lymph Node Ratio in a Population-Based Collective of Colorectal Cancer Patients
复制标题
DOI：
10.1097/sla.0b013e3181d7789d
复制
发表时间：
2010-06-01
影响因子：
9
通讯作者：
Hoelzel, Dieter
中科院分区：
文献类型：
--
作者：
Rosenberg, Robert;Engel, Jutta;Hoelzel, Dieter
目的：我们分析了先前确定的3个淋巴结比率的临界值（0.17,0.41和0.69），以确定其在以人群为基础的结直肠癌患者群体中的预后价值。背景资料：淋巴结比（LNR）（肿瘤浸润与总检查淋巴结的关系）对预后有很高的影响，但相关的临界值尚未确定。方法：1991年至2006年间在慕尼黑地区诊断并手术的原发性结直肠癌患者（N = 27,803）在慕尼黑癌症登记处登记。17309例患者的淋巴结数目和生存数据，平均随访5.9年。结果：平均切除淋巴结数（±SD）为16.8±8.4。76.8%的患者切除了12个或更多淋巴结。估计5年总生存率随着LNR的增加而显著降低：71.4%的LNR = 0, 52.4%的LNR为0.01 ~ 0.17,33.3%的LNR为0.18 ~ 0.41,19.8%的LNR为0.42 ~ 0.69,8.3%的LNR为0.70 （P < 0.001）。多变量生存分析分别确定LNR和pN-类别，以及切除淋巴结数量，患者年龄，肿瘤位置，pt类别，pm状态，r状态，肿瘤分级和手术年份作为独立的预后因素。结论：LNRs的3个临界值在以人群为基础的结直肠癌患者群体中具有很强的独立预后价值。LNR应定期报告，并纳入美国癌症分期联合委员会。然而，淋巴结切除术对生存的益处仍不清楚。
Objective: We analyzed 3 previously identified cut-off values of lymph node ratios (0.17, 0.41, and 0.69) in a large population-based collective of patients with colorectal cancer for their prognostic value.Summary Background Data: The lymph node ratio (LNR) (relation of tumor-infiltrated to total examined lymph nodes) has a high prognostic impact, but the relevant cut-off values are not determined.Methods: Patients (N = 27,803) with a primary colorectal cancer diagnosed and operated in the Munich region between 1991 and 2006 were registered in the Munich Cancer Registry. Lymph node numbers and survival data were available for 17,309 patients with a mean follow-up of 5.9 years.Results: The mean number (+/- SD) of resected lymph nodes was 16.8 +/- 8.4. Twelve or more lymph nodes were resected in 76.8%. Estimated 5-year overall survival decreased significantly with increasing LNR: LNR = 0 in 71.4%, LNR 0.01 to 0.17 in 52.4%, LNR 0.18 to 0.41 in 33.3%, LNR 0.42 to 0.69 in 19.8%, and LNR >= 0.70 in 8.3% (P < 0.001). Multivariable survival analyses identified separately both LNR and pN- category, as well as number of resected lymph nodes, patient's age, tumor location, pT-category, pM-status, R-status, tumor grade, and year of operation as independent prognostic factors.Conclusion: The 3 cut-off values of LNRs had strong independent prognostic value in a population-based collective of patients with colorectal cancer. The LNR should be routinely reported and included in the American Joint Committee on Cancer staging system. Nevertheless, the benefit of lymphadenectomy on survival is still unclear.