Dukes B 대장암에서 병리 검사한 림프절의 수가 예후에 미치는 영향
Impact of the Number of Nodes Examined on the Prognosis of Dukes B Colorectal Cancer
오수연, 이석환, 구혜수, 김광호, 박응범,
소속 상세정보
오수연 ( Oh Soo-Youn )
이화여자대학교 의과대학 외과학교실
이석환 ( Lee Seok-Hwan )
이화여자대학교 의과대학 외과학교실
구혜수 ( Koo Hea-Soo )
이화여자대학교 의과대학 병리학교실
김광호 ( Kim Kwang-Ho )
이화여자대학교 의과대학 외과학교실
박응범 ( Park Eung-Bum )
이화여자대학교 의과대학 외과학교실
KMID : 0356720030190030157
Abstract
Purpose: Metastasis to the regional lymph nodes is the most important prognostic indicator in patients with colorectal cancer (CRC). The number of lymph nodes examined for adequate staging is still controversial. The aim of this study was to determine if the number of lymph nodes after curative surgery is associated with long-term outcome in patents with Dukes B CRC.
Methods: A retrospective analysis was performed in 174 consecutive patients with Dukes B CRC who underwent curative resection from 1990 to 1999. Patients were stratified according to the number of nodes examined as group A (less than 12 nodes) and group B (12 or more nodes). End-points were local and systemic recurrence and relapse-free survival. Comparisons between the groups were performed by Kaplan-Meier methods and chi-square test as appropriate.
Results: There were 115 men (66%). The mean number of nodes examined was 13.4 with the median of 11. No significant difference was found in the number of nodes examined between colon and rectum (16+/-10.6 vs. 13+/-10.0, P=0.675). However, the number of lymph nodes examined tends to be more in recent period of study and if the specimens were examined in the fresh status. With the median follow-up of 44 months, there were 5 local recurrences (2.9%), 22 systemic recurrences (12.6%), and 2 combined local and systemic recurrences (1.1%). Most of the recurrences were observed in group A (79%). The difference of 5-year relapse-free survival rates between the groups was also statistically significant (group A: 73.5%, group B: 91.7%, log-rank test, P=0.0114). The pT stage and number of lymph nodes examined were the independent variables associated with relapse-free survival in multivariate analysis.
Conclusion: The number of lymph nodes examined has prognostic value in patients undergoing curative resection for CRC. Based on our analysis, we recommended at least 12 lymph nodes should be analyzed for accurate staging of CRC.
키워드
림프절 전이;Dukes B 대장암;예후인자
Lymph node metastasis;Dukes B colorectal cancer;Prognostic indicator
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