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目的:通过研究结直肠癌单个转移的淋巴结分布情况及其在预后中的作用,探讨淋巴结转移规律及转移位置的预后评估价值。方法:收集分析中山大学附属肿瘤医院1993年2月～2008年6月行根治性手术且术后常规病理检测只有一个淋巴结转移结直肠腺癌患者资料。结果:共收集病例263例,单个淋巴结跳跃转移率35%。淋巴结转移分布影响因素多分类Logistic回归示送检淋巴结个数和病理分级是影响系膜组淋巴结转移因素,年龄是影响系膜动脉结扎处淋巴结转移因素。TNM分期ⅢA期5年生存率88.4%,ⅢB期73.1%,5年生存有差异。中国分期Dukes’C_1期和Dukes’C_2期5年生存无显著性差异。影响预后因素cox回归显示5年生存率与性别、病理分级、淋巴结转移率、TNM分期有关。结论:单个转移的淋巴结有很高的概率分布在远离肿瘤的位置,清扫系膜根部淋巴结是必要的。淋巴结转移率而不是淋巴结转移位置对生存率有显著影响,按淋巴结转移位置进行分期意义不大。
OBJECTIVE: To investigate the distribution of lymph node metastasis and its prognostic role in colorectal cancer and to explore the prognostic value of lymph node metastasis and metastasis location. Methods: The data of patients with colorectal adenocarcinoma with lymph node metastasis who underwent radical surgery and routine pathological examination from February 1993 to June 2008 at Cancer Hospital Affiliated to Sun Yat-sen University were collected and analyzed. Results: A total of 263 cases were collected, and the rate of single lymph node metastasis was 35%. Multi-classification Logistic regression showed that the number of sentinel nodes and pathological grade were the factors influencing lymph node metastasis in mesangial cells, and age was the factor affecting the lymph node metastasis in the ligation of mesangial arteries. TNM stage Ⅲ A 5-year survival rate of 88.4%, Ⅲ B 73.1%, 5-year survival difference. There was no significant difference in 5-year survival between China Dukes’C_1 and Dukes’C_2. The prognosis factors cox regression showed that 5-year survival rate and gender, pathological grade, lymph node metastasis, TNM staging. CONCLUSIONS: Single metastatic lymph nodes have a high probability of being located distant from the tumor, and mesangial lymph node dissection is necessary. Lymph node metastasis, but not lymph node metastasis, has a significant effect on survival, and it is of little value to stage lymph node metastasis.