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目的探索Ⅲ期结直肠癌的淋巴结转移比率与其临床病理特征及预后的关系。方法将247例Ⅲ期结直肠癌患者根据淋巴结转移比率(MLR)的中位数分为3个组:低比率组(≤0.21),中比率组(>0.21～0.42),高比率组(>0.42)。分析比较各组的临床病理因素和5年生存率的差别,并采用Cox比例风险模型分析Ⅲ期结直肠癌预后的相关因素。结果 247例Ⅲ期结直肠癌的淋巴结转移比率为0.02～1.00,中位数为0.21,在低比率组中,高中分化的结直肠癌的所占比例(57.9%,113/195)明显高于低分化癌的比例(23.1%,12/52)(P<0.01);≥12枚病检淋巴结的结直肠癌所占比例(56.5%,95/168)明显高于<12枚淋巴结的比例(38.0%,30/79)(P<0.05)。低比率组、中比率组、高比率组的5年生存率分别为67.4%,28.8%,6.3%,3组生存率存在明显差异(P<0.05)。多因素Cox回归模型分析表明,淋巴结转移比率是Ⅲ期结直肠癌预后的重要因素。结论 MLR是判断Ⅲ期结直肠癌预后的一个重要指标。
Objective To explore the relationship between the lymph node metastasis rate and its clinicopathological features and prognosis in stage Ⅲ colorectal cancer. Methods According to the median lymph node metastasis rate (MLR), 247 patients with stage Ⅲ colorectal cancer were divided into three groups: low ratio group (≤0.21), middle ratio group (> 0.21 ~ 0.42), high ratio group (> 0.42). The differences of clinical pathological factors and 5-year survival rate between groups were analyzed and compared, and the prognostic factors of stage Ⅲ colorectal cancer were analyzed by Cox proportional hazards model. Results The lymph node metastasis rate was 0.02 to 1.00 and the median was 0.21 in 247 patients with stage Ⅲ colorectal cancer. The proportion of high-differentiated colorectal cancer in the low-ratio group (57.9%, 113/195) was significantly higher (23.1%, 12/52) (P <0.01). The proportion of colorectal cancer with ≥12 lesions (56.5%, 95/168) was significantly higher than that of <12 lymph nodes 38.0%, 30/79) (P <0.05). The 5-year survival rates were 67.4%, 28.8% and 6.3% in low, middle and high ratio groups, respectively. There were significant differences in survival rates between the three groups (P <0.05). Multivariate Cox regression model analysis showed that the lymph node metastasis rate is an important factor in the prognosis of stage Ⅲ colorectal cancer. Conclusion MLR is an important index to judge the prognosis of stage Ⅲ colorectal cancer.