DCR:患有良性肠系膜淋巴结肿大的结直肠癌患者的预后与普通患者不同

2022-06-29 xuyihan MedSci原创

肠系膜淋巴结是人体正常组织结构,在人体免疫功能中发挥重要作用。肠系膜淋巴结出现肿大一般常见炎症,主要表现为腹痛、发热及消化道症状,如消化不良等,易和其它外科急腹症相混淆。

结直肠癌(CRC)的淋巴结转移通常被认为是与较高的复发率和较差的预后相关。五年总体无淋巴结转移的 II 期患者生存率为 82.5%,然而,III 期患者的比率仅为 59.5%。同时,良性肠系膜术后组织病理学证实淋巴结肿大(BLNE)是否影响结直肠癌患者的长期预后目前还不清楚。炎症过程通常引起淋巴细胞和间充质的增殖,良性淋巴的预后独立于分子改变(例如微卫星不稳定性)的淋巴结增生在 CRC 患者中没有明确证明。因此,本研究的目的是评估结直肠癌患者良性肠系膜淋巴结肿大的临床意义。

这是一项前瞻性队列研究,纳入了2010年1月至2014年4月在中国天津、山东和浙江的 601 名处于 0、I 和 II 期结直肠癌患者。所有患者均接受了根治性手术,并根据存在良性肠系膜淋巴结肿大分为 2 组:肿大组(n = 275)和普通对照组(n = 326)。然后研究人员通过构建单变量对数秩和多变量 Cox 回归分析以确定复发和死亡率的危险因素。

研究结果显示肿大组根治性切除术后复发风险明显低于对照组,肿大1年、3年、5年无病生存率分别为97.1%、91.6%、86.9%组和对照组分别为 95.7%、86.2% 和 78.2%(p = 0.004)。肿大组术后1、3、5年总生存率分别为99.6%、94.9%、90.5%,对照组分别为99.4%、91.4%、82.1%(p= 0.001)。与对照组相比,增大组患者年龄较小、有家族肿瘤史、右侧肿瘤和较大肿瘤的患者比例较高。对于肿大组患者,淋巴结肿大数量与无病生存期或总生存期之间未观察到显着相关性(p= 0.113 和 0.386)。调整后的 Cox 回归模型显示,良性肠系膜淋巴结肿大是无病生存期(HR,0.587;95% CI,0.399-0.861;p= 0.007)和总生存期(HR,0.506;95%)的独立预后危险因素CI,0.328–0.779;p= 0.002)。

本项研究总共分析了 601 例 CRC 患者的临床病理特征,良性肠系膜淋巴结肿大可以成为预测结直肠癌患者复发和长期生存的有用积极因素。

 

原始出处:

Huang, Xianghui. Et al. Prognostic Characteristics of Patients With Colorectal Cancer Who Have Benign Mesenteric Lymph Node Enlargement: A Multi-institutional Cohort Study. Diseases of the Colon & Rectum.2022.

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    2022-06-28 sodoo
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    2022-06-28 zzc2216

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