| Objective：The purpose of this study was to explore the relationship between the number,metastasis of lymph nodes and the colorectal cancer of degree II, III, so that we canprovide a more reasonable basis for clinical staging and treatment.Method:We retrospective collect and analysis of the clinical and pathological data of thepatients who underwent the colorectal cancer radical operation and reached the degreeof II, III, totally1240cases, in Liaoning Province Tumor Hospital from2003Januaryto2008December. We included691cases of stage II,549cases in stage III,443caseswith colon cancer and797rectal cancer patients. All the patients were required to meetthe following criteria:⑴a diagnosis of idiopathic II, III colon cancer,⑵underwentthe colorectal cancer radical operation,⑶with a complete clinical and pathologicaldata and follow-up data, and followed up for more than5years,⑷the postoperativespecimens diagnosed by two pathologists, and no residual tumor, lymph node detectionused the traditional manual method,⑸the patients who conforms to the postoperativeadjuvant chemotherapy, was recommended to the relevant departments for adjuvantchemoradiotherapy.All data collected were grouped and made tabs according to the gender(the male or female),age(<65,≥65years old),tumor site(colon, rectum),and tumor differentiationdegree(the high, mid, low);patients of stage II were grouped by lymph nodes numberdetected1-3,4-6,7-9,10-12,>12packet;in stage III, patients of lymph nodes detected1-3,4-6,7-12,>12packet; stage III patients lymph node metastasis degree weregrouped according to LNR1:0.01~0.18, LNR2:0.19~0.46, LNR3:0.47~0.74andLNR4:0.75~1group, all groups of patients with clinical pathological data, see table1.The1240cases of patients were followed up by phone, letters and visits. We askedin detail about the general situation and tumor recurrence, metastases time, the deathcause and time of death of the patients.The clinical and pathological data wascalculated the survival rate in5years using SPSS17software, and each sub group forstatistical analysis: using histograms and scatterplots we analyzed the distribution oflymph nodes detection and the corresponding number of cases and the transfer number,using the survival curves to analyze the influence of the different lymph nodenumber detected and lymph node metastasis on the prognosis of the patients.Result:(1) The5year survival rates of different cases grouped by the clinical andpathological factors were compared and the analysis results show: the degree of tumordifferentiation, tumor location, lymph node detection and lymph nodes metastasis weresignificant correlation with prognosis in patients, but gender, age were unrelated to thatin patients.(2) In the total cases of1240patients, the lymph node positive number ranges1~47(12.4±4.6)/cases, and in all cases14174medals of which the positive lymphnodes detected was2250medals. The detection of lymph node number and thecorresponding number of cases distribution is shown in figure1.The distribution of thedetection of lymph node and the metastasis of lymph node number is shown in figure2.(3) Statistically we analyzed the influence of lymph nodes detection on prognosis ofpatients of stage II, and the number of lymph nodes were grouped according to 1-3,4-6,7-9,10-12,>12pieces. We used survival analysis method of Kaplan-Meiercalculated the patients5years survival rate and survival curves were drawn, resultsshowed that: when lymph node number detected was1-3pieces, its5years ofexistence rate was59.1%;when the number of detected was4-6pieces, its5yearsurvival rate was77.8%; when the detected number was7-9pieces,its5year survivalrate was84.8%; when the detected number was10-12pieces, its5year survival ratewas90.7%;when the detection number was>12pieces,then its5year survival ratewas89.1%. There was a statistically significant difference in5years survival rate(X2=25.709P=0.000) survival curve is shown in figure3.(4) Statistically we analyzed the influence of lymph nodes detection on prognosis ofpatients of stage III, and the number of lymph nodes were grouped according to1-3,4-6,7-12,>12pieces. We used survival analysis method of Kaplan-Meiercalculated the patients5years survival rate and survival curves were drawn, resultsshowed that: when the detection number was1-3pieces, its5year survival rate was53.2%; when the detection number was the4-6pieces,its5year survival rate was52.8%;when the detection number was7-12pieces, its5year survival rate was62.3%;when the detection number was>12pieces, its5year survival rate was78.9%. Therewas a statistically significant difference in5years survival rate (X2=28.947P=0.000)survival curve is shown in figure4.(5) The group III patients with lymph node metastasis degree were groupedaccording to LNR1:0.01~0.18, LNR2:0.19~0.46, LNR3:0.47~0.74and LNR4:0.75~1group. The survival analysis method of Kaplan-Meier was used to determine the5year survival rates, and the result were83.3%,67.9%,55.3%,36.6%, the differencewas statistically significant (X2=82.240P=0.000),survival curve is shown in figure5.Conclusion:Stage II colorectal cancer patients’prognosis was significantly related to lymphnodes detected，the patients who did not meet according to the detection of lymph nodestaging a number, can add the detection of lymph node number to accurate clinical staging of colorectal cancer patients. Lymph node metastasis degree and prognosis ofcolorectal cancer patients in stage III colon were significantly related, and can be usedindependently to evaluate the clinical prognosis. |
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