Lymph node evaluation and survival after curative resection of colon cancer: Systematic review
Lymph node evaluation and survival after curative resection of colon cancer: Systematic review
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DOI：
10.1093/jnci/djk092
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发表时间：
2007-03-21
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影响因子：
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通讯作者：
Moyer, Virginia A.
中科院分区：
文献类型：
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作者：
Chang, George J.;Rodriguez-Bigas, Miguel A.;Moyer, Virginia A.
背景 对癌症累及情况进行充分的淋巴结评估对于结肠癌患者的预后和治疗非常重要。评估的淋巴结数量可能是结肠癌护理质量的衡量标准，但对于大多数接受结肠癌治疗的患者来说，评估的淋巴结数量似乎不足。我们对结肠癌患者淋巴结评估与肿瘤学结果之间关联的证据进行了系统回顾。方法检索了 1990 年 1 月 1 日至 2006 年 6 月 30 日期间的 Medline、Scopus、Cochrane 和国家指南信息交换所数据库，以查找可获得生存数据与评估淋巴结数量函数关系的研究。对这些研究的方法质量、设计和数据源进行了评估。共纳入61371例患者。 结果 来自9个国家的17项研究符合系统评价条件，其中包括2项结肠癌辅助化疗多中心随机试验的二次分析、5项基于人群的观察性研究和10项单机构回顾性队列研究。尽管方法存在异质性，评估的淋巴结阈值数量也存在差异（范围 = 6-40 个淋巴结），但 17 项研究中有 16 项报告称，II 期结肠癌患者的生存率增加与评估的淋巴结数量增加相关。六项针对 III 期患者数据的研究中的四项也报告了与 III 期结肠癌患者的生存期呈正相关。 结论 手术切除后评估的淋巴结数量与 II 期和 III 期结肠癌患者的生存期呈正相关。这些结果支持考虑将评估的淋巴结数量作为结肠癌护理质量的衡量标准。
Background Adequate lymph node evaluation for cancer involvement is important for prognosis and treatment of patients with colon cancer. The number of lymph nodes evaluated may be a measure of quality in colon cancer care and appears to be inadequate in most patients treated for colon cancer. We performed a systematic review of the evidence for the association between lymph node evaluation and oncologic outcomes in patients with colon cancer.Methods Medline, Scopus, Cochrane, and the National Guidelines Clearinghouse databases were searched from January 1, 1990, through June 30, 2006, for studies in which survival data as a function of number of lymph nodes evaluated were available. These studies were evaluated for methodologic quality, design, and data source. A total of 61371 patients were included.Results Seventeen studies from nine countries were eligible for systematic review, including two secondary analyses of multicenter randomized trials of adjuvant chemotherapy for colon cancer, five population-based observational studies, and 10 single-institution retrospective cohort studies. Despite heterogeneity in methodology and differences in threshold numbers of lymph nodes evaluated (range = 6-40 lymph nodes), 16 of 17 studies reported that increased survival of patients with stage II colon cancer was associated with increased numbers of lymph nodes evaluated. Four of six studies with data from stage III patients also reported a positive association with survival among patients with stage III colon cancer.Conclusions The number of lymph nodes evaluated after surgical resection was positively associated with survival of patients with stage II and stage III colon cancer. These results support consideration of the number of lymph nodes evaluated as a measure of the quality of colon cancer care.