More extensive nodal dissection improves survival for stages I to III of colon cancer - A population-based study
More extensive nodal dissection improves survival for stages I to III of colon cancer - A population-based study
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DOI：
10.1097/01.sla.0000237655.11717.50
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发表时间：
2006-10-01
影响因子：
9
通讯作者：
Bilchik, Anton J.
中科院分区：
文献类型：
--
作者：
Chen, Steven L.;Bilchik, Anton J.
目的：探讨结肠癌标本中多分析淋巴结是否能提高生存率。背景数据：据报道，增加淋巴结分析数量与淋巴结阴性结肠癌患者生存率的提高有密切关系。方法：对1988年至2000年间所有接受组织学证实的结肠癌切除术的患者的监测、流行病学和最终结果数据库进行查询。患者排除远处转移或如果一个未知数目的淋巴结取样。采样节点个数分为0、1 ~ 7、8 ~ 14和>= 15个节点。采用Kaplan-Meier法构建的生存曲线采用对数秩检验进行比较。建立Cox比例风险模型，调整诊断年份、年龄、种族、性别、肿瘤分级、肿瘤大小、TNM分期和肿瘤阳性淋巴结百分比。结果：82,896例患者中位淋巴结取样数为9。对于所有阶段的研究，增加淋巴结采样与生存率的提高有关。多变量回归表明，与其他患者和肿瘤特征无关，至少取样15个淋巴结的患者的死亡率降低了20.6%，而取样1至7个淋巴结的患者的死亡率降低了20.6%。结论：通过对至少15个淋巴结的分析，充分的淋巴结切除术与生存率的提高相关，与分期、患者人口统计学和肿瘤特征无关。目前，大多数程序不符合这一准则。未来的辅助治疗试验应将淋巴结切除程度作为分层因素。
Objective: To determine whether analyzing more lymph nodes in colon cancer specimens improves survival.Summary Background Data: Increasing the number of lymph nodes analyzed has been reported to cot-relate with improved survival in patients with node-negative colon cancer.Methods: The Surveillance, Epidemiology, and End Results database was queried for all patients undergoing resection for histologically confirmed colon cancer between the years 1988 and 2000. Patients were excluded for distant metastases or if an unknown number of nodes was sampled. The number of nodes sampled was categorized into 0, 1 to 7, 8 to 14, and >= 15 nodes. Survival curves constructed using the Kaplan-Meier method were compared using log rank testing. A Cox proportional hazard model was created to adjust for year of diagnosis, age, race, gender, tumor grade, tumor size, TNM stage, and percent of nodes positive for tumor.Results: The median number of lymph nodes sampled for all 82,896 patients was 9. For all stages examined, increasing nodal sampling was associated with improved survival, Multivariate regression demonstrated that patients who had at least 15 nodes sampled as compared with 1 to 7 nodes experienced a 20.6% reduction in mortality independent of other patient and tumor characteristics.Conclusions: Adequate lymphadenectomy, as measured by analysis of at least 15 lymph nodes, correlates with improved survival, independent of stage, patient demographics, and tumor characteristics. Currently, most procedures do not meet this guideline. Future trials of adjuvant therapy should include extent of lymphadenectomy as a stratification factor.