阳性淋巴结比率对结直肠癌患者预后的预测价值

摘要

目的 探讨阳性淋巴结比率(LNR)对有淋巴结转移的结直肠癌患者3年生存率和3年无病生存率的预测价值.方法 收集2003年7月到2007年12月接受根治性手术的102例有淋巴结转移的散发性结直肠癌患者的临床病理资料.根据四分位法将患者按LNR值分为4组,分别为LNR1(LNR≤第25百分位数)、LNR2(第25百分位数＜LNR≤第50百分位数)、LNR3(第50百分位数＜LNR＜第75百分位数)和LNR4(LNR≥第75百分位数).用Kaplan-Meier法进行生存分析,用Cox比例风险回归模型进行生存多因素分析.结果 102例Ⅲ、Ⅳ期结直肠癌患者的3年生存率为72.5％,3年无病生存率为61.8％.腺癌、低级别分化患者的3年生存率更高(P＜0.05).LNR1、LNR2、LNR3和LNR44组患者的3年生存率分别为100.0％、76.9％、68.0％和42.3％ (P ＜0.001),3年无病生存率分别为92.0％、61.5％、68.0％和26.9％ (P ＜0.001).Kaplan-Meier生存分析显示,LNR1+LNR2组的3年生存率和3年无病生存率显著高于LNR3+ LNR4组(P＜0.05).Cox风险回归模型显示,LNR是结直肠癌患者预后的独立预测指标(P =0.036).结论 LNR能够准确判断结直肠癌患者的预后.%Objective To investigate the prognostic value of lymph node ratio(LNR) in predicting overall survival and disease-free survival in colorectal cancer(CRC) patients with metatastic lymph nodes.Methods From July 2003 to December 2007,data from a total of 102 patients who underwent radical operation for CRC with lymph node metastases were analyzed.The patients were stratified into four groups according to LNR quartiles:LNR1 (LNR ≤ Q1),LNR2 (Q1 ＜ LNR ≤ Q2),LNR3 (Q2 ＜ LNR ＜ Q3) and LNR4 (LNR ≥ Q3).Kaplan-Meier method was used to evaluate the survival.A Cox regression model was used for multivariate analyses.Results The 3-year overall survival rate and disease-free survival rate were 72.5％ and 61.8％ in CRC patients with stage Ⅲ-Ⅳ.The 3-year overall survival rate in patients with adenocarcinoma and low grade differentiation was higher(P ＜ 0.05).The 3-year overall survival rates of patients with LNR1,LNR2,LNR3 and LNR4 were 100.0％,76.9％,68.0％ and 42.3 ％,respectively (P ＜ 0.001).The 3-year disease-free survival rates of patients with LNR1,LNR2,LNR3 and LNR4 were 92.0％,61.5％,68.0％ and 26.9％,respectively(P ＜ 0.001).Kaplan-Meier analysis showed that the prognosis in LNR1 + LNR2 group was superior to LNR3 + LNR4 group(P ＜0.05).Cox proportional hazards regression analysis revealed that LNR was an independent significant factor in predicting 3-year overall and disease-free survival for CRC patients(P =0.036).Conclusion The LNR is a major independent prognostic factor for the CRC patients with node-positive.