本研究旨在评估淋巴结比率(LNR)对接受根治性CRC手术的结直肠癌(CRC)患者的短期和长期预后的影响。我们回顾性收集了2011年1月至2020年1月在单中心医院接受根治性手术的CRC患者。根据中位数将患者分为高LNR组和低LNR组。比较高组和低组的基线信息和短期结果。采用单因素和多因素logistic回归分析总生存期(OS)和无病生存期(DFS)的独立预测因子。使用1:1比例倾向评分匹配(PSM)来减少两组之间的选择偏倚。采用Kaplan-Meier法估计两组不同T分期的OS和DFS。本研究共纳入1434例接受根治性手术的CRC患者,低LNR组有730例(50.9%)患者,高LNR组有704例(49.1%)患者。在PSM之后,两组都有618名患者,两组患者基线特征差异无统计学意义(p>0.05)。在比较手术相关信息和短期结果后,高LNR组的住院时间更长(PSM后,p<0.01)。在单变量和多变量逻辑回归分析中,年龄(单变量分析,p<0.01;多变量分析,p<0.01),肿瘤位置(单变量分析,p=0.020;多变量分析,p=0.024),淋巴-血管间隙侵犯(单变量分析,p<0.01;多变量分析,p<0.01),癌结节(单变量分析,p<0.01;多变量分析,p<0.01),肿瘤大小(单变量分析,p<0.01;多变量分析,p<0.01),LNR(单变量分析,p<0.01;多变量分析,p<0.01),和总体并发症(单变量分析,p<0.01;多变量分析,p<0.01)是OS的独立危险因素,和年龄(单变量分析,p<0.01;多变量分析,p<0.01),肿瘤位置(单变量分析,p=0.032;多变量分析,p=0.031),T阶段(单变量分析,p<0.01;多变量分析,p=0.014),淋巴-血管间隙侵犯(单变量分析,p<0.01;多变量分析,p<0.01),癌结节(单变量分析,p<0.01;多变量分析,p<0.01),LNR(单变量分析,p<0.01;多变量分析,p<0.01),和总体并发症(单变量分析,p<0.01;多变量分析,p<0.01)被确定为DFS的独立危险因素。高LNR组T3(p<0.01)和T4(p<0.01)的OS差,T3(p<0.01)和T4(p<0.01)的DFS差。LNR与术后并发症无相关性,但高LNR组住院时间较长。LNR被确定为OS和DFS的独立预测因子。此外,在T3和T4阶段,高LNR的OS和DFS较差。因此,对于T3和T4期的CRC患者,LNR更具预后意义。
The current study aimed to evaluate the effect of lymph node ratio (LNR) on the short-term and long-term outcomes of colorectal cancer (CRC) patients who underwent radical CRC surgery. We retrospectively collected CRC patients who underwent radical surgery from Jan 2011 to Jan 2020 in a single-center hospital. The patients were divided into the high LNR group and the low group according to the median. The baseline information and the short-term outcomes were compared between the high group and the low group. Univariate and multivariate logistic regression was performed to analyze the independent predictors for overall survival (OS) and disease-free survival (DFS). A 1:1 proportional propensity score matching (PSM) was used to reduce the selection bias between the two groups. Kaplan-Meier method was used to estimate the OS and DFS between the two groups in different T stages. A total of 1434 CRC patients undergoing radical surgery were enrolled in this study, and there were 730 (50.9%) patients in the low LNR group and 704 (49.1%) patients in the high LNR group. After the PSM, there were 618 patients in both groups, the baseline characteristics between the two groups had no significant difference (p > 0.05). After comparing the Surgery-related information and The Short-term outcomes, the high LNR group had a longer hospital stay (after PSM, p < 0.01). In univariate and multivariate logistic regression analyses, age (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor location (univariate analysis, p = 0.020; multivariate analysis, p = 0.024), lymph-vascular space invasion (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), cancer nodules (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor size (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), LNR (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), and overall complications (univariate analysis, p < 0.01; multivariate analysis, p < 0.01) were independent risk factors for OS, and age (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), tumor location (univariate analysis, p = 0.032; multivariate analysis, p = 0.031), T stage (univariate analysis, p < 0.01; multivariate analysis, p = 0.014), lymph-vascular space invasion (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), cancer nodules (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), LNR (univariate analysis, p < 0.01; multivariate analysis, p < 0.01), and overall complications (univariate analysis, p < 0.01; multivariate analysis, p < 0.01) were identified as independent risk factors for DFS. The high LNR group had a worse OS in T3 (p < 0.01) and T4 (p < 0.01) as well as a worse DFS in T3 (p < 0.01) and T4 (p < 0.01). No association was found between LNR and postoperative complications, but the high LNR group had a longer hospital stay. LNR was identified as an independent predictor for OS and DFS. Furthermore, high LNR had a worse OS and DFS under T3 and T4 stages. Therefore, LNR was more prognostically significant for CRC patients under T3 and T4 stages.