【摘要】 目的 探讨淋巴结转移数目对行手术治疗的结肠癌患者预后的影响。 方法 回顾性分析2005年1月-2007年12月符合筛选标准的148例行手术治疗的结肠癌患者的临床和随访资料，按照淋巴结转移数目进行分组：N0组（0枚）91例、N1组（1～3枚）41例、N2组（≥4枚）16例，采用Kaplan-Meier法进行生存分析，用Log-rank比较3组术后3年生存率，等级资料采用秩和检验，用χ2检验进行两两比较术后3年局部复发率、远处转移率和死亡率情况。 结果 N0、N1、N2 3组的术后3年生存率分别为88.1%、71.4%、61.1%，3组生存率差异有统计学意义（P=0.003）；N0、N1、N2 3组的总体局部复发率、远处转移率和死亡率的差异有统计学意义（P=0.006，0.001，0.005）。 结论 淋巴结转移数目是结肠癌患者术后3年生存情况的危险因素，无淋巴结转移的患者术后3年生存情况明显比有淋巴结转移者好。
【Abstract】 Objective To discuss the impact of the number of lymph node metastasis on the prognosis of patients with colon cancer after surgical operation. Methods The clinical data of 148 patients with colon cancer who underwent surgical operation between January 2005 and December 2007 were analyzed retrospectively. According to the number of lymph node metastasis, the patients were divided into three groups, group N0(the number of lymph metastasis equals to 0), group N1(the number of lymph node metastasis ranges from 1 to 3) and group N2 (the number of lymph node metastasis was equal or greater than 4). And we chose Kaplan-Meier to analyze patients′ survival and Log-rank test was used to compare the 3-year survival index; rank sum test was used to analyze the level data, and then chi-square test was chosen to compare local recurrence rate, metastasis rate and mortality among the three groups. Results The indexes of the 3-year survival in group N0 (91 cases), group N1 (41 cases) and group N2(16 cases) wre 88.1%, 1.4%, and 61.1%, respectively. The differences were significant (P=0.003). Besides, the differences between group N0 and N1, N0 and N2 were both significant (P=0.012,0.002); the differences between group N1 and N2 was not significant (P=0.344). The differences among three groups in local recurrence rate, metastasis rate and mortality were all significant(P=0.006, 0.001, 0.005); the differences between group N0 and N1 in local recurrence rate, metastasis rate and mortality were significant (P=0.008, 0.000, 0.012); the differences between group N0 and N2 in local recurrence rate, metastasis rate and mortality were significant (P=0.021, 0.047, 0.010), while the differences between group N1 and N2 in local recurrence rate, metastasis rate and mortality were not significant (P=1.000,0.585,0.523). Conclusion The number of lymph node metastasis is a dangerous factor to the 3-year survival in patients with colon cancer after operation, and the prongnosis of the 3-year survival in patients without lymph node metastasis is better than that in patients′ with lymph node metastasis.
Citation：
YANG Xiaoling,LI Xue,WANG Zhengdong,HUANG Mingjun,WANG Xiaodong,LI Ka. Impact of the Number of Lymph Node Metastasis on the Prognosis of Patients with Colon Cancer. West China Medical Journal, 2011, 26(11): 1672-1675. doi:
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Copyright © the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
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- 1. 韩洪秋, 刘彤, 赵丽中, 等. 国际新的TNM分期对分析结直肠癌预后的临床意义[J]. 中华医学杂志, 2006, 86(12): 819-821.
- 2. 李力人, 万德森, 潘志忠, 等. 大肠癌淋巴结转移对预后的影响[J]. 广东医学, 2006, 27(12): 1819-1821.
- 3. Carlos A, Victor Im, Gustavo L, et al. Lymph Node Ratio as Prognosis Factor for Colon Cancer Treated by Colorectal Surgeons[J]. Dis Colon rectum, 2009, 52(7): 1244-1250.
- 4. 张玉科, 董新舒, 赵家宏, 等. 大肠癌淋巴转移特点[J]. 实用肿瘤杂志, 1989, 4(3): 134-136.
- 5. Kelder W, Inberg B, Schaapveld M, et al. Impact of the Number of Histologically Examined Lymph Nodes on Prognosis in Colon Cancer: A Population-Based Study in The Netherlands[J]. Dis Colon Rectum, 2009, 52(2): 260-267.
- 6. Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer[J]. World J Surg, 2007, 31(7): 1485-1490.
- 7. 赵东兵, 高纪东, 淡毅, 等. 结肠癌根治术后转移复发的特点及预后分析[J]. 中华胃肠外科杂志, 2006, 9(4): 291-293.
- 8. Halsted W. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to Jannuary, 1894[J]. Ann Surg, 1894, 20(5): 497-555.
- 9. 佟金学, 张玉科, 赵家宏, 等. 结肠癌淋巴转移与病理因素关系探讨[J]. 中国肿瘤临床, 1995, 22(12): 866-868.
- 10. 龚少敏, 彭开勤, 刘丽江, 等. 淋巴结转移数目在结直肠癌预后判断中的意义[J]. 江汉大学学报(医学版), 2002, 30(1): 21-24.
- 11. Michelle A, Ostadi JL, Harnish SS, et al. Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens[J]. Surg Endosc, 2007, 21(12): 2142-2146.
- 12. Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis[J]. Int J Radiat Oncol Biol Phys, 2005, 61(2): 426-431.
