Lymph node ratio: Role in the staging of node-positive colon cancer
Lymph node ratio: Role in the staging of node-positive colon cancer
复制标题
DOI：
10.1245/s10434-007-9716-x
复制
发表时间：
2008-06-01
影响因子：
3.7
通讯作者：
Kulaylat, Mahmoud N.
中科院分区：
文献类型：
--
作者：
Wang, Jiping;Hassett, James M.;Kulaylat, Mahmoud N.
背景：最近的文献表明，在预测除结肠癌以外的其他几种恶性肿瘤的预后方面，淋巴结比(LNR)优于阳性淋巴结数(PLN)。我们假设LNR在III期结肠癌中可能扮演着类似的角色。方法：我们从监测、流行病学和最终结果癌症登记中收集了24,477例III期结肠癌病例。根据截断点1/14、0.25和0.50，患者被分成四组，LNR1到LNR1 4。用Kaplan-Meier和Cox比例风险模型评估预后效果，估计LNR的相对危险度(RR)和95%可信区间(CI)。结果：IIIA、IIIB和IIIC期患者的5年生存率分别为71.3%、51.7%和34.0%(P<；0.0001)。对于IIIA期患者，LNR1和LNR4的生存期无差异。在IIIB期患者中，LNR1~LNR4患者的5年生存率分别为63.5%、54.7%、44.4%和34.2%(P<；0.0001)。在IIIC期患者中，LNR2~LNR4患者的5年生存率分别为49.6%、41.7%和25.2%(P<；0.0001)。在调整了患者的年龄、肿瘤大小、肿瘤分级、种族、PLN数量和获取的LN总数后，LNR是一个独立的生存预测因子。(RR 2.30，95%CI 2.08-2.55)。结论：IIIB期和IIIC期结肠癌患者是一个异质性群体，大多数患者要么被高估，要么被低估。对于III期结肠癌患者，LNR是一种更准确的预后评估方法。我们提出了一种将LNR融入到现有的AJCC分期系统中的算法。
Background: Recent literature has shown that lymph node ratio (LNR) is superior to the number of positive lymph nodes (pLNs) in predicting the prognosis in several malignances other than colon cancer. We hypothesize that LNR may play a similar role in stage III colon cancer.Methods: We included 24,477 stage III colon cancer cases from the Surveillance, Epidemiology, and End Results cancer registry. Patients were categorized into four groups, LNR1 to 4, according to cutoff points 1/14, 0.25, and 0.50. Kaplan-Meier and Cox proportional hazard model were used to evaluate the prognostic effect and estimate the relative risk (RR) and 95% confidence interval (CI) of LNR.Results: The 5-year survival for patients with stage IIIA, IIIB, and IIIC was 71.3%, 51.7%, and 34.0%, respectively (P < .0001). There was no survival difference among LNR1 to LNR4 for stage IIIA patients. In stage IIIB patients, the 5-year survival for those with LNR1 to LNR4 was 63.5%, 54.7%, 44.4%, and 34.2%, respectively (P < .0001). In stage IIIC patients, the 5-year survival for those with LNR2 to LNR4 was 49.6%, 41.7%, and 25.2%, respectively (P < .0001). LNR is an independent predictor of survival after adjusting patient's age, tumor size, tumor grade, race, number of pLNs, and total number of LNs harvested. (RR 2.30, 95% CI 2.08-2.55).Conclusion: Patients with stage IIIB and IIIC colon cancer represent a heterogeneous group of patients with the majority either overstaged or understaged. LNR is a more accurate prognostic method for stage III colon cancer patients. We propose an algorithm to incorporate LNR into current AJCC staging system.