淋巴结转移数目对结肠癌患者预后的影响

【】　目的　探讨淋巴结转移数目对行手术治疗的结肠癌患者预后的影响。　方法　回顾性分析2005年1月-2007年12月符合筛选标准的148例行手术治疗的结肠癌患者的临床和随访资料，按照淋巴结转移数目进行分组N0组（0枚）91例、N1组（1～3枚）41例、N2组（≥4枚）16例，采用Kaplan-Meier法进行生存分析，用Log-rank比较3组术后3年生存率，等级资料采用秩和检验，用χ2检验进行两两比较术后3年局部复发率、远处转移率和死亡率情况。　结果　N0、N1、N23组的术后3年生存率分别为88.1%、71.4%、61.1%，3组生存率差异有统计学意义（P=0.003）；N0、N1、N23组的总体局部复发率、远处转移率和死亡率的差异有统计学意义（P=0.006，0.001，0.005）。　结论　淋巴结转移数目是结肠癌患者术后3年生存情况的危险因素，无淋巴结转移的患者术后3年生存情况明显比有淋巴结转移者好。【Abstract】　Objective　Todiscusstheimpactofthenumberoflymphnodemetastasisontheprognosisofpatientswithcoloncanceraftersurgicaloperation.　Methods　Theclinicaldataof148patientswithcoloncancerwhounderwentsurgicaloperationbetweenJanuary2005andDecember2007wereanalyzedretrospectively.Accordingtothenumberoflymphnodemetastasis,thepatientsweredividedintothreegroups,groupN0(thenumberoflymphmetastasisequalsto0),groupN1(thenumberoflymphnodemetastasisrangesfrom1to3)andgroupN2(thenumberoflymphnodemetastasiswasequalorgreaterthan4).AndwechoseKaplan-Meiertoanalyzepatients′survivalandLog-ranktestwasusedtocomparethe3-yearsurvivalindex;ranksumtestwasusedtoanalyzetheleveldata,andthenchi-squaretestwaschosentocomparelocalrecurrencerate,metastasisrateandmortalityamongthethreegroups.　Results　Theindexesofthe3-yearsurvivalingroupN0(91cases),groupN1(41cases)andgroupN2(16cases)wre88.1%,1.4%,and61.1%,respectively.Thedifferencesweresignificant(P=0.003).Besides,thedifferencesbetweengroupN0andN1,N0andN2werebothsignificant(P=0.012,0.002);thedifferencesbetweengroupN1andN2wasnotsignificant(P=0.344).Thedifferencesamongthreegroupsinlocalrecurrencerate,metastasisrateandmortalitywereallsignificant(P=0.006,0.001,0.005);thedifferencesbetweengroupN0andN1inlocalrecurrencerate,metastasisrateandmortalityweresignificant(P=0.008,0.000,0.012);thedifferencesbetweengroupN0andN2inlocalrecurrencerate,metastasisrateandmortalityweresignificant(P=0.021,0.047,0.010),whilethedifferencesbetweengroupN1andN2inlocalrecurrencerate,metastasisrateandmortalitywerenotsignificant(P=1.000,0.585,0.523).　Conclusion　Thenumberoflymphnodemetastasisisadangerousfactortothe3-yearsurvivalinpatientswithcoloncancerafteroperation,andtheprongnosisofthe3-yearsurvivalinpatientswithoutlymphnodemetastasisisbetterthanthatinpatients′withlymphnodemetastasis.