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目的评价Ⅰ~Ⅲ期结直肠癌淋巴结转移比率与患者预后的关系。方法回顾性分析中山大学附属第一医院胃肠胰腺外科2004年6月至2008年11月间446例行根治性切除的结直肠癌患者临床病理数据,探讨结直肠癌预后相关危险因素,评估结直肠癌淋巴结转移比率与患者预后的关系。结果 446例结直肠癌Ⅰ、Ⅱ、Ⅲ期患者的5年总体生存率分别约为87.4%,83.1%和64.8%(Log-rank检验,P<0.001)。我们根据淋巴结转移比率(metastatic lymph node ratio,mLNR)将CRC患者分为三组:A组:mLNR为0;B组:m LNR为>0%~14%;C组:mLNR为>14%。A、B、C组三组患者的5年总体生存率分别约为84.3%、79.6%和49.1%(Log-rank检验,χ2=55.959,P<0.001)。就直肠癌患者而言,A、B、C三组5年生存率分别为79.0%、73.5%和43.2%(Log-rank检验,χ~2=26.332,P<0.001)。而对于结肠癌患者来说三组的5年生存率分别为87.1%,80.8%和55.5%(Log-rank检验,χ~2=21.214,P<0.001)。单因素和多因素Cox分析均显示,mLNR是结直肠癌独立的预后危险因素,随着m LNR的上升,结直肠癌患者的预后变差。结论淋巴结转移比率(mLNR)是结直肠癌患者预后的独立危险因素,与N分期类似,但更有优势,可作为评估结直肠癌患者预后的指标之一。
Objective To evaluate the relationship between the lymph node metastasis rate and the prognosis of patients with stage Ⅰ ~ Ⅲ colorectal cancer. Methods The clinical and pathological data of 446 patients with colorectal cancer who underwent radical resection from June 2004 to November 2008 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The risk factors of prognosis of colorectal cancer were discussed. Relationship between Lymph Node Metastasis Rate and Prognosis in Patients with Rectal. Results The 5-year overall survival rates of 446 patients with stage I, II and III colorectal cancer were 87.4%, 83.1% and 64.8% respectively (Log-rank test, P <0.001). We divided CRC patients into three groups based on the metastatic lymph node ratio (mLNR): group A: mLNR was 0; group B: m LNR was> 0% to 14%; group C: mLNR was> 14%. The 5-year overall survival rates of the three groups were 84.3%, 79.6% and 49.1% respectively (Log-rank test, χ2 = 55.959, P <0.001). For patients with rectal cancer, the 5-year survival rates in groups A, B and C were 79.0%, 73.5% and 43.2%, respectively (Log-rank test, χ ~ 2 = 26.332, P <0.001). For patients with colon cancer, the 5-year survival rates were 87.1%, 80.8% and 55.5% for the three groups (Log-rank test, χ 2 = 21.214, P <0.001). Univariate and multivariate Cox analyzes showed that mLNR was an independent prognostic risk factor for colorectal cancer, with the prognosis of patients with colorectal cancer deteriorating as m LNR increased. Conclusion The lymph node metastasis rate (mLNR) is an independent risk factor for prognosis of patients with colorectal cancer. It is similar to N stage but has more advantages and can be used as an index to evaluate the prognosis of patients with colorectal cancer.