结直肠癌淋巴结转移率在TNM分期中地临床意义.docxVIP

·英文论著摘要· The clinical significance of lymph node metastasis rate in the TNM classification system for colorectal cancer obj ective The lymph node ratio(LNR)，namely,the ratio of positive LNs divided by the total number of retrieved LNs，reflects the probability of positive LNs in the retrieved LNs，which does not significantly depend on the number of LNs harvested．Lymph node ratio(LNR)has been reported to represent a powerful independent prognostic value in some malignancies．The significance of LNR in colorectal c习fflcer is still under debate． Methods 505 patients with stage III colorectal CanCer Were reviewed．Using running log-rank statistics，We calculated the best cut-off values for LNRs and proposed a novel rN category：rNl，0％LNRR35％；rN2，35％LNR弋69％and rN3，LNR69％．A Spearman’ S correlation coefficient test was used to assess the correlation between the number of retrieved nodes and the number of metastatic nodes，as well as the number of retrieved nodes and the LNRs．Univariate and 2-step multivariate analyses were performed，respectively,tO identify the significant prognostic clinicopathologic factors． Results The 5-year overall survival rate decreased signi ficantly with increasing LNRs：rN l =6 1％survival rate，rN2=30．3％survival rate，and rN3=1 1．2％survival rate (p 0．00 1)．Univariate and 2-step multivariate analyses identified rN category as a significant prognostic factor no matter whether the minimum number of LNs retrieved Was met．There Was a significant prognostic difference among different rN categories 3 for any pN category,but no apparent prognostic difference was seen between different pN categories in any rN category．Moreover,marked heterogeneity could be seen within Ilia-c substages when survival was compared among rN 1—3 categories but not between pN 1-2 categories． Conclusions rN categories have more potential for predicting patient outcomes and are superior to the UICC／AJCC pN categories．We recommend rN categories for pr