| Objectives: The number of deaths due to colorectal cancer(CRC)in the world annually,directly or indirectly,exceeds 500,000,mainly in developed countries.There is a significant difference in the incidence of colorectal cancer in various regions of the world.In 2017,the American Cancer Society released the latest epidemiological results of colorectal cancer.The results show that the overall incidence of colorectal cancer and overall mortality in the United States have declined year by year.In 2015,the epidemiological results of colorectal cancer released by the National Cancer Center of China showed that the incidence of colorectal cancer was significantly higher in both men and women in 10 years.In terms of mortality,the performance of male patients increased year by year.Trends,while women tend to be relatively stable.The development of the correct treatment plan for patients with colorectal cancer and the prognosis of the patient's prognosis depends on correct patient staging.Of the known prognostic factors,the number of regional lymph nodes that have been identified for metastasis is the most important predictor of colon and rectal cancer.This variable forms the basis of the staging system of the current tumor-node and metastasis(TNM)system.The TNM system proposed by the American Joint Cancer Committee(AJCC)/International Union Against Cancer(UICC)is currently considered to be the strongest prognostic indicator for patients with colorectal cancer.In the latest TNM staging of the eighth edition,the staging of N was stratified according to the absolute number of metastatic lymph nodes,but this staging method was criticized as oversimplification,and the prognostic value of N stage was limited by the number of lymph node acquisitions.Lymph node metastasis rate(LNR),the ratio of the number of metastatic lymph nodes to the total number of lymph nodes obtained,reflects the proportion of metastatic lymph nodes in lymph nodes.The purpose of this study was toinvestigate the relationship between lymph node metastasis and prognosis in patients with stage III colon cancer,and to provide more reasonable tumor stage,better treatment options,and prognosis for stage III colon cancer patients.Materials and methods: A retrospective analysis of the clinical pathological data of 136 patients with stage III colon cancer undergoing radical surgery for colon cancer from January 2012 to October 2017 in Guangzhou First People's Hospital was performed.All patients were required to meet the following criteria:(1)confirmed stage III colon cancer(as determined by the eighth edition of the AJCC stage);(2)performed radical surgery for colon cancer;(3)patients had complete clinical pathology data and follow-up data;(4)All patients received adjuvant chemotherapy after surgery.Exclusion criteria:(1)metastasis or death within 1 month after surgery;(2)multiple colon cancer;(3)familial adenomatous polyposis or hereditary non-polyposis colon cancer;(4)preoperative administration Patients with neoadjuvant chemotherapy or radiotherapy;(5)previous history of other cancers;(6)incomplete data affect the judges.All enrolled patients were followed until December 31,2017.Twelve out of the cases we included were lost and follow-up compliance was 98.50%.Our median follow-up time was 24.7 months and the average follow-up time was 28.2±18.1 months.Data collected from 136 patients included age,sex,tumor site,tumor differentiation,surgical approach,presence or absence of chronic disease,pT staging,pN staging,TNM staging,number of lymph node acquisitions,rate of lymph node metastasis,surgery date,recurrent metastasis,or Date of death,cause of death,follow-up time,etc.All collected patient data were recorded in groups and tabulated and analyzed: sex divided by men and women;age grouped by ?35 years old,35-60 years old,and >60 years old group: tumor sites were divided into right colon and left colon;tumors The degree of differentiation was divided into high,medium,and low groups;chronic diseases were grouped according to whether they had or not;surgical methods were grouped by laparoscopic surgery and laparotomy;number of lymph nodes obtained was grouped by <12,?12;grouping;lymph node metastasis rate was LNR1:0.01 ~ 0.083,LNR2: 0.083 ~ 0.167,LNR3: 0.167 ~ 0.389,and LNR4: 0.389 ~ 1.00 grouping.The general clinical data and pathological features of patients are shown in Table 1.The 136 patients enrolled in the study were followed up in the hospital or outpatient department.The basic data,perioperative data,surgical methods,pathological data,tumor stage,time of tumor recurrence,metastasis,death cause and death of the death patients were collected in detail.At the time of follow-up,the deadline for follow-up was December 31,2017.The survival time was defined as the time from surgery to recurrence or death.After follow-up,each clinical pathological data was analyzed according to the above-mentioned grouping criteria for frequency distribution of each group and tabulated.Chi-square test was used for single factor analysis to compare count data and Mann-Whitney U test to compare measurement data.Kaplan-Meier method was used to estimate the 5-year survival rate and 5-year survival rate from the date of diagnosis.The log-rank test was used to compare the survival rate among the groups.COX risk regression models were used to identify the predictors of 5-year disease-free survival and 5-year overall survival.Using SPSS 16.0 software for statistics,we believe that P<0.05 was statistically significant.Results:(1)Of the 136 patients enrolled,81 were male and 55 were female,with an average age of 58.8±1.17 years.Of these,91 had 1 to 3 lymph node metastases(pN1)and 45 had ? 4 lymph node metastases(pN2).The median follow-up time was 24.7months.The 5-year disease-free survival rate and overall survival rate were 48.00% and54.00%,respectively.(2)The average number of lymph node acquisitions was 15.6±8.8,and the median was 14(2,43).The total number of lymph node acquisitions was 2126: The mean number of positive lymph node acquisitions was 3.3±3.1,median For 2(1,15)pieces,the total number of positive lymph nodes was 450.(3)In order to study the effect of lymph node number on the prognosis of patients with stage III colon cancer,the number of obtained lymph nodes was divided into <12groups and ?12 groups.The Kaplan-Meier survival analysis was used to estimate the5-year disease-free survival rate of the two groups of patients.The 5-year survival rate and the survival curve were plotted.The results showed that when the number of lymph node acquisition was less than 12,the 5-year survival rate and 5-year survival rate of the patients were 33.90% and 39.50%,respectively;the number of lymph nodes obtained was?12 At that time,the 5-year survival rate and 5-year survival rate of the patients were70.50% and 77.10%,respectively.We can see that the prognosis of the larger number of lymph nodes is better than the number of lymph nodes.Log-rank test was used to test the two groups respectively.The 5-year disease-free survival rate and 5-year survival rate of the patients showed that there was a statistically significant difference between the two groups(P<0.05),and the survival curves were shown in Figures 1 and 2.(4)In order to study the prognostic value of TNM staging in patients with stage III colon cancer,all patients in stage III were screened according to the TNM staging of the eighth edition of AJCC,grouped by stage IIIA,IIIB,and IIIC,using survival analysis Kaplan-Meier's method was used to calculate the 5-year survival rate and 5-year survival rate of the three groups of patients and the survival curve was plotted.The results showed that the 5-year disease-free survival rate and 5-year survival rate in stage IIIA were80.00% and 75.00% respectively;stage IIIB The five-year disease-free and 5-year survival rates were 73.90% and 76.90%,respectively,while the 5-year disease-free and 5-year survival rates in the IIIC phase were 16.10% and 26.20%,respectively.It can be seen that the IIIC phase survives.The prognosis was significantly worse than those in stage IIIA and IIIB Log-rank test was used to analyze the 5-year disease-free survival rate and 5-year survival rate of the three groups.The results showed that there was a statistically significant difference between the three groups(P<0.05),survival curves are shown in Figures 3 and 4.(5)To investigate the prognostic value of lymph node metastasis in patients with stage III colon cancer,the lymph node metastasis rate of patients with stage III colon cancer was LNR1: 0.01 ~ 0.083,LNR2: 0.083 ~ 0.167,LNR3: 0.167 ~ 0.389,and LNR4.:0.389 ~ 1.00 quartile method for grouping.Survival analysis Kaplan-Meier method was used to calculate five-year disease-free survival rate and five-year survival rate of four groups of patients and to draw a survival curve.The five-year disease-free survival rate in the four-component group was 92.5%,89.6%,50.9%,and 27.6%,respectively.The 5-year survival rates were 93.5%,73.3%,54.2%,and 20.9%,respectively,as can be seen with lymph nodes.As the rate of metastasis increased,the prognosis of the four groups gradually worsened.Log-rank test was used to analyze the 5-year disease-free survival rate and 5-year survival rate of the four groups of patients.The results showed that the prognosis of the four groups was statistically significant(P<0.05),survival curves are shown in Figures 5 and 6.(6)Analyze and compare the patient's clinical pathological factors with the patient's5-year disease-free survival rate and 5-year survival rate.Our single-factor analysis results show(Table 1): Poor tumor differentiation,high T staging,high N staging,high TNM staging,fewer lymph node acquisitions,and high lymph node metastasis rates were associated with poor 5-year disease-free and 5-year survival rates(P<0.05),and patients' gender,age,The location of the tumor,the surgical procedure,and the presence or absenceof chronic disease were not associated with a 5-year survival rate and a 5-year survival rate(P>0.05).A multivariate analysis of the factors that may influence the prognosis(Table 2)showed that T staging,N staging,TNM staging,lymph node acquisition,and LNR were all significant independent prognostic factors(P<0.05).We analyzed the stratification(<12 lymph nodes,?12 lymph nodes)according to the number of lymph nodes obtained(Table 3).The results showed that the prognostic value of LNR was not related to the number of lymph nodes obtained,and its prognostic value was not affected by the number of lymph nodes obtained.Conclusion: The lymph node metastasis rate is significantly related to the prognosis of patients with stage III colon cancer,and the lymph node metastasis rate is not affected by the number of lymph node acquisition.It is a significant independent prognostic factor for stage III colon cancer and can be used as a stage predictor for TNM stage III colon cancer patients.Complementary to the prognosis. |
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