楊小玲 1,2 , 李雪 1,2 , 王正東 1,2 , 黃明君 1,2 , 汪曉東 2,3 , 李卡 2,3
  • 四川大學（成都，610041）1華西護理學院， 2 華西醫(yī)院MCQ團隊， 3 華西醫(yī)院胃腸外科中心;

【摘要】　目的　 探討淋巴結(jié)轉(zhuǎn)移數(shù)目對行手術(shù)治療的結(jié)腸癌患者預(yù)后的影響。　方法　 回顧性分析2005年1月-2007年12月符合篩選標準的148例行手術(shù)治療的結(jié)腸癌患者的臨床和隨訪資料，按照淋巴結(jié)轉(zhuǎn)移數(shù)目進行分組：N0組（0枚）91例、N1組（1～3枚）41例、N2組（≥4枚）16例，采用Kaplan-Meier法進行生存分析，用Log-rank比較3組術(shù)后3年生存率，等級資料采用秩和檢驗，用χ2檢驗進行兩兩比較術(shù)后3年局部復(fù)發(fā)率、遠處轉(zhuǎn)移率和死亡率情況。　結(jié)果　 N0、N1、N2 3組的術(shù)后3年生存率分別為88.1%、71.4%、61.1%，3組生存率差異有統(tǒng)計學意義（P=0.003）；N0、N1、N2 3組的總體局部復(fù)發(fā)率、遠處轉(zhuǎn)移率和死亡率的差異有統(tǒng)計學意義（P=0.006，0.001，0.005）。　結(jié)論　 淋巴結(jié)轉(zhuǎn)移數(shù)目是結(jié)腸癌患者術(shù)后3年生存情況的危險因素，無淋巴結(jié)轉(zhuǎn)移的患者術(shù)后3年生存情況明顯比有淋巴結(jié)轉(zhuǎn)移者好。
【Abstract】　Objective　 To discuss the impact of the number of lymph node metastasis on the prognosis of patients with colon cancer after surgical operation.　Methods　 The clinical data of 148 patients with colon cancer who underwent surgical operation between January 2005 and December 2007 were analyzed retrospectively. According to the number of lymph node metastasis, the patients were divided into three groups, group N0(the number of lymph metastasis equals to 0), group N1(the number of lymph node metastasis ranges from 1 to 3) and group N2 (the number of lymph node metastasis was equal or greater than 4). And we chose Kaplan-Meier to analyze patients′ survival and Log-rank test was used to compare the 3-year survival index; rank sum test was used to analyze the level data, and then chi-square test was chosen to compare local recurrence rate, metastasis rate and mortality among the three groups.　Results　 The indexes of the 3-year survival in group N0 (91 cases), group N1 (41 cases) and group N2(16 cases) wre 88.1%, 1.4%, and 61.1%, respectively. The differences were significant (P=0.003). Besides, the differences between group N0 and N1, N0 and N2 were both significant (P=0.012,0.002); the differences between group N1 and N2 was not significant (P=0.344). The differences among three groups in local recurrence rate, metastasis rate and mortality were all significant(P=0.006, 0.001, 0.005); the differences between group N0 and N1 in local recurrence rate, metastasis rate and mortality were significant (P=0.008, 0.000, 0.012); the differences between group N0 and N2 in local recurrence rate, metastasis rate and mortality were significant (P=0.021, 0.047, 0.010), while the differences between group N1 and N2 in local recurrence rate, metastasis rate and mortality were not significant (P=1.000,0.585,0.523).　Conclusion　 The number of lymph node metastasis is a dangerous factor to the 3-year survival in patients with colon cancer after operation, and the prongnosis of the 3-year survival in patients without lymph node metastasis is better than that in patients′ with lymph node metastasis.

引用本文： 楊小玲,李雪,王正東,黃明君,汪曉東,李卡. 淋巴結(jié)轉(zhuǎn)移數(shù)目對結(jié)腸癌患者預(yù)后的影響. 華西醫(yī)學, 2011, 26(11): 1672-1675. doi: 復(fù)制

1. 　韓洪秋, 劉彤, 趙麗中, 等. 國際新的TNM分期對分析結(jié)直腸癌預(yù)后的臨床意義[J]. 中華醫(yī)學雜志, 2006, 86(12): 819-821.
2. 　李力人, 萬德森, 潘志忠, 等. 大腸癌淋巴結(jié)轉(zhuǎn)移對預(yù)后的影響[J]. 廣東醫(yī)學, 2006, 27(12): 1819-1821.
3. 　Carlos A, Victor Im, Gustavo L, et al. Lymph Node Ratio as Prognosis Factor for Colon Cancer Treated by Colorectal Surgeons[J]. Dis Colon rectum, 2009, 52(7): 1244-1250.
4. 　張玉科, 董新舒, 趙家宏, 等. 大腸癌淋巴轉(zhuǎn)移特點[J]. 實用腫瘤雜志, 1989, 4(3): 134-136.
5. 　Kelder W, Inberg B, Schaapveld M, et al. Impact of the Number of Histologically Examined Lymph Nodes on Prognosis in Colon Cancer: A Population-Based Study in The Netherlands[J]. Dis Colon Rectum, 2009, 52(2): 260-267.
6. 　Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer[J]. World J Surg, 2007, 31(7): 1485-1490.
7. 　趙東兵, 高紀東, 淡毅, 等. 結(jié)腸癌根治術(shù)后轉(zhuǎn)移復(fù)發(fā)的特點及預(yù)后分析[J]. 中華胃腸外科雜志, 2006, 9(4): 291-293.
8. 　Halsted W. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to Jannuary, 1894[J]. Ann Surg, 1894, 20(5): 497-555.
9. 　佟金學, 張玉科, 趙家宏, 等. 結(jié)腸癌淋巴轉(zhuǎn)移與病理因素關(guān)系探討[J]. 中國腫瘤臨床, 1995, 22(12): 866-868.
10. 　龔少敏, 彭開勤, 劉麗江, 等. 淋巴結(jié)轉(zhuǎn)移數(shù)目在結(jié)直腸癌預(yù)后判斷中的意義[J]. 江漢大學學報(醫(yī)學版), 2002, 30(1): 21-24.
11. 　Michelle A, Ostadi JL, Harnish SS, et al. Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens[J]. Surg Endosc, 2007, 21(12): 2142-2146.
12. 　Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis[J]. Int J Radiat Oncol Biol Phys, 2005, 61(2): 426-431.
  1. 1. 　韓洪秋, 劉彤, 趙麗中, 等. 國際新的TNM分期對分析結(jié)直腸癌預(yù)后的臨床意義[J]. 中華醫(yī)學雜志, 2006, 86(12): 819-821.
  2. 2. 　李力人, 萬德森, 潘志忠, 等. 大腸癌淋巴結(jié)轉(zhuǎn)移對預(yù)后的影響[J]. 廣東醫(yī)學, 2006, 27(12): 1819-1821.
  3. 3. 　Carlos A, Victor Im, Gustavo L, et al. Lymph Node Ratio as Prognosis Factor for Colon Cancer Treated by Colorectal Surgeons[J]. Dis Colon rectum, 2009, 52(7): 1244-1250.
  4. 4. 　張玉科, 董新舒, 趙家宏, 等. 大腸癌淋巴轉(zhuǎn)移特點[J]. 實用腫瘤雜志, 1989, 4(3): 134-136.
  5. 5. 　Kelder W, Inberg B, Schaapveld M, et al. Impact of the Number of Histologically Examined Lymph Nodes on Prognosis in Colon Cancer: A Population-Based Study in The Netherlands[J]. Dis Colon Rectum, 2009, 52(2): 260-267.
  6. 6. 　Chok KS, Law WL. Prognostic factors affecting survival and recurrence of patients with pT1 and pT2 colorectal cancer[J]. World J Surg, 2007, 31(7): 1485-1490.
  7. 7. 　趙東兵, 高紀東, 淡毅, 等. 結(jié)腸癌根治術(shù)后轉(zhuǎn)移復(fù)發(fā)的特點及預(yù)后分析[J]. 中華胃腸外科雜志, 2006, 9(4): 291-293.
  8. 8. 　Halsted W. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins Hospital from June 1889 to Jannuary, 1894[J]. Ann Surg, 1894, 20(5): 497-555.
  9. 9. 　佟金學, 張玉科, 趙家宏, 等. 結(jié)腸癌淋巴轉(zhuǎn)移與病理因素關(guān)系探討[J]. 中國腫瘤臨床, 1995, 22(12): 866-868.
  10. 10. 　龔少敏, 彭開勤, 劉麗江, 等. 淋巴結(jié)轉(zhuǎn)移數(shù)目在結(jié)直腸癌預(yù)后判斷中的意義[J]. 江漢大學學報(醫(yī)學版), 2002, 30(1): 21-24.
  11. 11. 　Michelle A, Ostadi JL, Harnish SS, et al. Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens[J]. Surg Endosc, 2007, 21(12): 2142-2146.
  12. 12. 　Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis[J]. Int J Radiat Oncol Biol Phys, 2005, 61(2): 426-431.