上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

淋巴结转移比率对局部进展期直肠癌患者预后的相关性分析

周荻，荣玲，白永瑞，叶明   

  1. 上海交通大学 医学院附属仁济医院放射诊疗科，上海 200127
  • 出版日期:2016-11-28 发布日期:2016-11-29
  • 通讯作者: 叶明，副主任医师，电子信箱：renjiyeming@163.com。
  • 作者简介:周荻（1982—），女，住院医师，硕士；电子信箱：sammy0804@sina.com。
  • 基金资助:

    上海交通大学医学院附属仁济医院临床科研创新培育基金（PYMDT-004）

Analysis of the correlation between lymph node ratio and the prognosis in patients with locally advanced rectal cancer

ZHOU Di, RONG Ling, BAI Yong-rui, YE Ming   

  1. Department of Radiation Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127
  • Online:2016-11-28 Published:2016-11-29
  • Supported by:

    Incubating Program for Clinical Research and Innovation of Renji Hospital, Shanghai Jiao Tong University School of Medicine，PYMDT-004

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摘要：

目的 ·探讨淋巴结转移比率（LNR）对局部进展期直肠癌术后总生存、无疾病生存的影响。方法 ·回顾性分析2005年7月至2013年3月行根治性切除手术的299例局部进展期直肠癌(T3/4或者N+)患者的临床资料。用ROC曲线分析法获得预测生存结局的最佳截断值，Kaplan-Meier法进行生存分析，Cox回归模型作多因素分析。结果 · 299例局部进展期直肠癌患者的5年生存率为30%，5年无疾病生存率为25%。LNR取值0.21（21%）能较好地预测生存及预后。低LNR组（LNR ≤0.21）的中位生存时间和中位无病生存时间显著高于高LNR组（LNR＞0.21），分别为59.6月（vs 39.5月，P=0.000）和30.0月（vs 19.5月，P=0.004）。单因素和多因素分析显示除了病理类型、肿瘤分化程度、脉管受侵、病检淋巴结总数、pN分期以及TNM分期以外，LNR是影响预后的一个重要因素。结论 · LNR是局部进展期直肠癌患者术后总生存和无疾病生存的一个重要的预测指标。

关键词: 直肠癌, 预后, 淋巴结转移比率

Abstract:

Objective · To investigate the effects of the lymph node ratio (LNR) on overall survival and disease free survival after surgeries in patients with locally advanced rectal cancer. Methods · We retrospectively analyzed clinical data of 299 patients who underwent curative resection for locally advanced rectal cancer (T3/4 or N+) between July 2005 and March 2010. The best cutoff value for predicting the survival outcome was obtained with ROC curve analysis method. Kaplan-Meier method was used to perform survival analysis and Cox regression models were used to conduct multivariate analysis. Results · The 5-year overall survival rate and 5-year disease free survival rate were 30% and 25% in 299 cases of locally advanced rectal cancer. Lymph node ratio of 0.21 (21%) could favorably predict the survival and prognosis. The median overall and disease-free survival rates were significantly higher in the low LNR group (LNR ≤0.21) than in the high LNR group (LNR＞0.21) (59.6 vs 39.5months, P=0.000; 30.0 vs 19.5 months, P =0.004). Univariate and multivariate analyses showed that besides pathological type, pathological differentiation, lymphovascular invasion, number of lymph nodes examined, pN stage, and TNM stage, LNR was an important factor for predicting the prognosis. Conclusion · LNR is an important factor for predicting the overall survival and disease free survival after surgeries in patients with locally advanced rectal cancer.

Key words: rectal cancer, prognosis, lymph node ratio