| Objective: Preliminary discussion the influence of No.253 lymph node metastasis on the prognosis of patients with rectal cancer and sigmoid colon cancer,The relationship between No.253 lymph node metastasis and paraaortic lymph node metastasis.Methods: The clinicopathological data,postoperative adjuvant treatment and follow-up prognosis of 159 patients with colorectal cancer and sigmoid colon cancer who were treated by radical surgery from January 1,2017 to February 1,2018 in the second Department of surgery,the fourth hospital of Hebei Medical University were retrospectively collected,and the lymph node metastasis between different stations was calculated,The survival analysis of the factors that may affect the prognosis was carried out.Kaplan Meier method was used to draw the survival curve and calculate the survival rate of the patients.Log rank test was used for the single factor analysis of the factors that may affect the prognosis,and Cox regression was used for the multi factor analysis the effect of No.253 lymph node metastasis on the prognosis of colorectal cancer.At the same time,different parts of the metastasis and The relationship of No.253 lymph node metastasis was analyzed by chi square test or Fisher exact test The relationship between No.253 lymph node metastasis and paraaortic lymph node metastasis.Results: 210 cases of colorectal cancer were collected,51 cases were excluded,and 159 cases of colorectal cancer and sigmoid colon cancer were included in the study.The ratio of the total number of metastatic lymph nodes to the total number of detected lymph nodes was 7.25%,The positive rate of lymph nodes in patients with stage ?colorectal cancer was 17.45%,The positive rate of No.253 lymph nodes in the lymph node group was 3.71%,No.253 The rate of lymph node metastasis was 9.43%,The follow-up rate of 159 patients with colorectal cancer was 96%,and the median follow-up time was 25 months.During the median follow-up time of 25 months,23 patients had tumor recurrence and metastasis,13 patients died,2-year disease-free survival rate and 2-year total survival rate were 85.3% and 91.7 %respectively?Univariate analysis showed that The difference of 2-DFS and 2-OS in the degree of tumor differentiation,neurovascular invasion,lymph node metastasis and No.253 lymph node metastasis was statistically significant(P < 0.05)?2-DFS was 94.5% and 72.4%(P < 0.05)in patients without lymph node metastasis and with lymph node metastasis respectively,2-OS was 98.9% and 81.4%(P < 0.05)respectively;2-DFS was 89.3% and 71.6%(P < 0.05)in the high and low differentiated colorectal cancer,2-OS was 94.2%?82.9%(P < 0.05);2-DFS was 67.2%? 92.8%(P < 0.05)and 2-OS was 78.1%?94.7%(P < 0.05)in Patients with nerve vessel invasion and non spirit meridian vessel invasion;The 2-DFS of No.253 lymph nodes without metastasis and metastasis were 90.1% and 40% respectively(p < 0.05),and 2-OS was 95.7% and 53.3% respectively(p < 0.05).However,there was no significant difference between 2-DFS and 2-OS(P>0.05)of KRAS gene,BRAF gene mutation,microsatellite.The results of survival analysis of colorectal cancer patients with lymph node metastasis showed that 2-DFS of N1 and N2 patients were 81.3% and 55.2%,respectively(P < 0.05),2-OS was 90.4% and 64.2%(P < 0.05);The 2-DFS of ?A,?B and ?C were 100%,84.1% and 50.8% respectively(p < 0.05).The 2-OS of the three groups were 100%,91.8% and 63.1% respectively(p < 0.05).2-DFS between non-metastatic and metastatic of No.253 lymph nodes were 82.1% and 40% respectively(p < 0.05),and 2-OS were 89.9% and 53.3% respectively(p < 0.05).Multivariate Cox regression analysis showed that No.253 lymph node metastasis was an independent factor influencing 2-DFS(HR = 3.732,95% CI: 1.442-9.659,P = 0.007)and 2-OS(HR = 4.751,95% CI: 1.450-15.563,P = 0.010)of colorectal cancer patients.No.253 lymph node metastasis was an independent factor influencing 2-DFS(HR=4.357,95%CI:1.709~11.110,P=0.002)and 2-OS(HR=5.779,95%CI:1.831~18.243,P=0.003)in patients with lymph node metastasis.Among patients with stage ?rectal cancer and sigmoid colon cancer,There was a significant difference in the incidence of paraaortic lymph node metastasis between patients with and without No.253 lymph node metastasis(33.3% vs 1.9%;P = 0.002).Conclusion: No.253 Lymph node metastasis is an independent prognostic risk factor for colorectal cancer and its progression,and is associated with poor prognosis of patients.The risk of paraaortic lymph node metastasis is higher in patients with No.253 lymph node metastasis,and there is a significant correlation between the two.As the number of metastatic lymph nodes and the number of lymph nodes increased,the adverse prognosis of colorectal cancer showed an upward trend.Colorectal cancer patients with neurovascular invasion and low tumor differentiation have poor prognosis. |
PDF Full Text Request