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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 204 -208. doi: 10.3877/cma.j.issn.1674-0793.2024.03.006

论著

阳性淋巴结比和阳性淋巴结对数比对结直肠癌患者预后价值的研究
孙姚承1, 汤建军1, 张伟元1, 刘传磊1,†()   
  1. 1. 213002　常州，徐州医科大学武进临床学院　江苏大学附属武进医院普通外科
  • 收稿日期:2023-12-25 出版日期:2024-06-01
  • 通信作者: 刘传磊
  • 基金资助:
    常州市科技计划资助项目(CJ20220005); 常州市卫生健康青苗人才培养工程资助项目(CZQM2021027); 常州市武进区科技计划（社会发展）资助项目(WS202010)

Study on the prognostic value of positive lymph node ratio and log odds of positive lymph nodes in colorectal cancer

Yaocheng Sun1, Jianjun Tang1, Weiyuan Zhang1, Chuanlei Liu1,†()   

  1. 1. Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Wujin Clinical College of Xuzhou Medical University, Changzhou 213002, China
  • Received:2023-12-25 Published:2024-06-01
  • Corresponding author: Chuanlei Liu
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孙姚承, 汤建军, 张伟元, 刘传磊. 阳性淋巴结比和阳性淋巴结对数比对结直肠癌患者预后价值的研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(03): 204-208.

Yaocheng Sun, Jianjun Tang, Weiyuan Zhang, Chuanlei Liu. Study on the prognostic value of positive lymph node ratio and log odds of positive lymph nodes in colorectal cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(03): 204-208.

目的

探讨阳性淋巴结比（LNR）和阳性淋巴结对数比（LODDS）对结直肠癌患者预后判断的价值。

方法

选取2017年1月至2018年12月在江苏大学附属武进医院诊断为结直肠癌并行根治性手术的患者206例，回顾性分析临床病理资料，并进行术后随访。分析LNR和LODDS与临床病理变量的关系，受试者工作特征（ROC）曲线比较阳性淋巴结数量（pN）、LNR、LODDS三种淋巴结分期对结直肠癌复发和生存评估的准确性。

结果

患者总体生存率与年龄、肿瘤部位、肿瘤分化程度、肿瘤大小、术后是否接受辅助治疗、肿瘤浸润程度（T）、淋巴结分期（N）、远处转移（M）、TNM分期、住院时间、LNR和LODDS分期均显著相关（P<0.05）。影响结直肠癌术后生存的独立因素是肿瘤分化程度、淋巴结转移、远处转移、TNM分期、LNR分期和LODDS分期（均P<0.01）。ROC曲线结果显示，pN、LNR、LODDS分期对复发（无瘤生存期）影响的曲线下面积分别为0.748、0.739、0.733，对总生存期影响的曲线下面积分别为0.739、0.725、0.720（P<0.001）。

结论

LNR和LODDS显著影响结直肠癌患者总体生存率，是影响结直肠癌术后生存的独立因素，故可作为pN分期不足时的有效补充，且LNR优于LODDS。

关键词: 结直肠肿瘤, 淋巴结比率, 阳性淋巴结比, 阳性淋巴结对数比, 阳性淋巴结数量, 预后, 存活率分析
Objective

To investigate the value of positive lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in the prognosis of colorectal cancer patients.

Methods

A total of 206 patients who underwent radical surgery for colorectal cancer in Wujin Hospital Affiliated to Jiangsu University from January 2017 to December 2018 were retrospectively analyzed and followed up after surgery. The relationship between LNR and LODDS and clinicopathological variables was analyzed. The accuracy of positive lymph node number (pN), LNR, and LODDS stage was used in evaluating the recurrence and survival of colorectal cancer using the receiver operating characteristic (ROC) curve.

Results

The overall survival rate of colorectal cancer patients was significantly correlated with age, tumor location, degree of tumor differentiation, tumor invasion degree, tumor size, postoperative adjuvant therapy, the number of lymph node metastases (N), distant metastases (M), tumor TNM stage, length of hospital stay, LNR and LODDS stage (P<0.05). The independent factors affecting the survival of colorectal cancer after surgery were degree of tumor differentiation, lymph node metastasis, distant metastasis, TNM stage, LNR stage and LODDS stage (all P<0.01). The results of ROC curve showed that the area under the curve of pN, LNR and LODDS stages on recurrence (tumor free survival) were 0.748, 0.739 and 0.733, respectively, and the area under the curve for the effect on overall survival were 0.739, 0.725 and 0.720, respectively (P<0.001).

Conclusions

LNR and LODDS significantly affect the overall survival rate of colorectal cancer patients, and they are independent factors affecting the survival of colorectal cancer after surgery. Therefore, they can be used as effective supplements when pN stage is insufficient, and LNR is better than LODDS.

Key words: Colorectal neoplasms, Lymph node ratio, Positive lymph node ratio, Log odds of positive lymph nodes, Positive lymph node number, Prognosis, Survival analysis
图1 阳性淋巴结比（LNR）对结直肠癌患者总生存率影响的Kaplan-Meier曲线　LNR0（<0.05）、LNR1（0.05~0.20）、LNR2（>0.20）
图2 阳性淋巴结对数比（LODDS）对结直肠癌患者总生存率影响的Kaplan-Meier曲线　LODDS0（<-1.36）、LODDS1（-1.36~-0.53）和LODDS2（>-0.53）
表1 结直肠癌患者临床病理资料与总生存率关系
变量 例(%) 3年总生存率(%) 5年总生存率(%) P值
性别       0.664
男 121(58.7) 81.0 66.9  
女 85(41.3) 75.3 64.7  
年龄(岁)       0.029
≤66 105(51.0) 81.9 73.0  
>66 101(49.0) 75.2 58.4  
肿瘤部位       0.050
直肠 168(81.6) 85.4 69.0  
结肠 38(18.4) 71.1 52.6  
肿瘤直径(cm)       0.018
<5 111(53.7) 82.5 76.3  
≥5 95(46.3) 69.4 57.6  
术后辅助治疗       <0.001
是 155(75.2) 66.3 49.7  
否 51(24.8) 93.5 87.6  
分化程度       <0.001
高 11(5.3) 90.9 72.7  
中 132(64.1) 85.6 75.8  
低 63(30.6) 61.9 44.4  
浸润深度(T)       0.002
T1 8(3.9) 100.0 100.0  
T2 25(12.1) 100.0 88.0  
T3 30(14.6) 93.3 76.7  
T4 143(69.4) 70.6 58.0  
pN分期       <0.001
N0 101(49.0) 92.1 84.2  
N1 57(27.7) 78.9 61.4  
N2 48(23.3) 50.0 33.3  
远处转移(M)       <0.001
M0 199(96.6) 80.6 67.3  
M1 7(3.4) 14.3 14.3  
TNM分期       <0.001
Ⅰ 28(13.6) 100.0 96.0  
Ⅱ 72(35.0) 88.9 79.2  
Ⅲ 99(48.1) 69.7 51.5  
Ⅳ 7(3.4) 14.3 14.3  
住院时间(d)       <0.001
≤19 134(65.0) 88.1 78.4  
>19 72(35.0) 61.1 43.1  
LNR分期       <0.001
LNR0 106(51.5) 92.5 84.0  
LNR1 41(19.9) 73.2 56.1  
LNR2 59(28.6) 57.6 40.7  
LODDS分期       <0.001
LODDS0 103(50.0) 92.2 83.5  
LODDS1 46(22.3) 73.9 58.7  
LODDS2 57(27.7) 57.9 40.4  
表2 影响结直肠癌患者复发率的多因素分析
变量 Exp(B) 95% CI P值
肿瘤分化程度 1.757 1.027~3.004 0.040
远处转移 2.082 1.284~3.377 0.003
淋巴结转移 2.025 1.182~3.469 0.010
TNM分期 2.646 1.396~5.015 0.003
LNR分期 2.043 1.210~3.347 0.009
LODDS分期 1.904 1.152~3.125 0.020
表3 影响结直肠癌患者总体生存率的多因素分析
变量 Exp(B) 95% CI P值
肿瘤分化程度 2.012 1.232~3.287 0.005
远处转移 1.993 1.198~3.346 0.005
淋巴结转移 2.171 1.253~3.764 0.006
TNM分期 2.385 1.241~4.584 0.009
LNR分期 1.973 1.218~3.152 0.004
LODDS分期 2.036 1.254~3.291 0.005
图3 三种淋巴结分期方法对结直肠癌患者无瘤生存期影响的ROC曲线比较
图4 三种淋巴结分期方法对结直肠癌患者总生存期影响的ROC曲线比较
表4 pN、LNR、LODDS对结直肠癌复发和生存评估的准确性比较
分期 无瘤生存期 总生存期
AUC 95% CI P值 AUC 95% CI P值
pN 0.748 0.676~0.819 <0.001 0.739 0.665~0.812 <0.001
LNR 0.739 0.666~0.811 <0.001 0.725 0.651~0.800 <0.001
LODDS 0.733 0.661~0.806 <0.001 0.720 0.645~0.795 <0.001
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