CAJ | 학술논문

目的探讨淋巴结转移率(MLR)在结直肠癌患者预后评估中的临床应用价值.方法回顾303例手术治疗的结直肠癌患者的临床资料,分析MLR和淋巴结转移数目与清扫淋巴结总数的相关性,以及影响结直肠癌患者预后的因素,探讨MLR预测结直肠癌患者术后5年生存情况的准确性,并与淋巴结转移数目的预测结果进行比较.结果 MLR与清扫淋巴结总数无相关性(r=-0.099,P＞0.05),而淋巴结转移数目与清扫淋巴结总数有相关性(r=0.107,P＜0.05).Kaplan-Meier生存分析显示,即使受检淋巴结总数＜12枚,MLR仍影响患者术后生存时间(X2=42.878,P＜0.01).rN0、rN1、rN2和rN3期患者的5年生存率分别为90.9%、68.9%、54.7%和39.4%,差异有统计学意义(P＜0.01).多因素分析显示,肿瘤大小和rN分期是影响结直肠癌患者预后的独立危险因素.通过比较相对危险度,独立危险因素与预后的密切程度依次为rN分期＞肿瘤大小.MLR和淋巴结转移数目预测结直肠癌患者术后5年生存的ROC曲线下面积比较,差异无统计学意义.结论结直肠癌患者的MLR与清扫淋巴结总数不相关;MLR是结直肠癌患者预后的主要独立危险因素;MLR预测结直肠癌患者术后5年生存情况的准确性与淋巴结转移数目的预测能力相同.
목적 탐토림파결전이솔(MLR)재결직장암환자예후평고중적림상응용개치.방법 회고303례수술치료적결직장암환자적림상자료,분석MLR화림파결전이수목여청소림파결총수적상관성,이급영향결직장암환자예후적인소,탐토MLR예측결직장암환자술후5년생존정황적준학성,병여림파결전이수목적 예측결과 진행비교.결과 MLR여청소림파결총수무상관성(r=-0.099,P＞0.05),이림파결전이수목여청소림파결총수유상관성(r=0.107,P＜0.05).Kaplan-Meier생존분석현시,즉사수검림파결총수＜12매,MLR잉영향환자술후생존시간(X2=42.878,P＜0.01).rN0、rN1、rN2화rN3기환자적5년생존솔분별위90.9%、68.9%、54.7%화39.4%,차이유통계학의의(P＜0.01).다인소분석현시,종류대소화rN분기시영향결직장암환자예후적독립위험인소.통과비교상대위험도,독립위험인소여예후적밀절정도의차위rN분기＞종류대소.MLR화림파결전이수목예측결직장암환자술후5년생존적ROC곡선하면적비교,차이무통계학의의.결론 결직장암환자적MLR여청소림파결총수불상관;MLR시결직장암환자예후적주요독립위험인소;MLR예측결직장암환자술후5년생존정황적준학성여림파결전이수목적 예측능력상동.
Objective To investigate the prognostic significance of metastatic lymph node ratio in patients with colorectal cancer.Methods The clinicopathological data of 303 surgically treated patients with colorectal cancer were retrospectively analyzed.Spearman correlation analysis was used to determine the correlation coefficient.The survival was analyzed using Kaplan-Meier method,and the survival difference was assessed by Log-rank test.Multivariate analysis was performed using Cox proportional hazard regression model in forward stepwise regression.Receiver working characteristic curve was used to compare the accuracy of the metastatic lymph nodes ratio in predicting the death of patients at 5 years postoperatively with that of the number of metastatic lymph nodes.Results The MLR was not correlated with the total number of dissected lymph nodes (Spearman correlation coefficient:-0.099,P＞0.05),but the positive rate of metastatic lymph nodes did ( correlation coefficient:0.107,P＜0.05).Kaplan-Meier survival analysis revealed that the MLR significantly influenced the postoperative survival time (Log-rank x2=42.878,P＜0.01),even in the patients with less than 12 resected lymph nodes.The 5-year survival rates for rN0,rN1,rN2 and rN3 were 90.9%,68.9%,54.7% and 39.4%,respectively.There was a significant difference between the different stages (P＜0.01).Cox proportional hazard regression model analysis showed that the metastatic lymph node ratio was an independent prognostic factor.(EXP(B)=7.809,P＜0.01).There was no significant difference between metastatic lymph node ratio and the number of metastatic lymph nodes in predicting the death of patients at 5 years postoperatively based on the area under the receiver working characteristic curve.Conclusion The metastatic lymph node ratio in colorectai cancer patients is not correlated with the total number of dissected lymph nodes.The metastatic lymph node ratio is a major independent prognostic factor for patients with colorectal cancer.The ability of metastatic lymph node ratio in predicting the death of colorectal cancer patients at 5 years postoperatively is the same as that of the number of metastatic lymph nodes.