Influence Of Lymph Node Ratio (LNR) And N Stage On Prognosis Of Stage ? Colorectal Cancer

Research purposes: Retrospective analysis may influence the risk factors of poor prognosis in primary colorectal cancer patients undergoing radical surgery in stage ?.To compare the effect of different factors on postoperative survival of patients with colorectal cancer,especially lymph node metastasis.By building the prognosis of patients with stage ? colorectal cancer judgment model,on postoperative adverse outcomes for patients with stage ? colorectal cancer effect a radical cure effective assessment,to develop more targeted disease surveillance and provide clinical basis for treatment and finally improve the patients' survival time and quality of life.Research materials and methods: This study collected in guangzhou medical university affiliated tumor hospital gastrointestinal tumor surgery in January 2011-December 2012 colorectal surgery treatment,a total of 322 patients with malignant tumor,which is suitable for stage I have 78 cases of postoperative pTNM staging,phase II in 98 patients,the phase ? in 146 patients.A total of 109 patients with colorectal cancer with postoperative pTNM stage ? were selected for analysis according to the relevant admission criteria and exclusion criteria.Collect into a group of patients with clinical and pathological data,including: gender,age,tumor location,tumor gross type,tumor diameter,pathological type,degree of tumor differentiation,tumor infiltration depth(T stage),lymph node metastasis(N staging,lymph node metastasis).Establish Excel database and use SPSS statistical software for statistical analysis.The life time is described by median,and the counting data is described by percentage.The optimal boundary point of LNR was determined by ROC curve.Multivariate Cox regression was used to analyze the effect of clinicopathological characteristics on LNR in stage ? colorectal cancer patients.The 5-year survival rate was calculated by kaplan-meier method and log-rank test.Using single factor analysis of the log-rank method,screening of meaningful prognosis related factors,and further using multiariable Cox proportional hazards regression model related to prognosis analysis,comparative N staging and LNR predictive value for stage ? colorectal cancer prognosis.The discriminant equation is established by discriminant analysis and verified by LOOCV method.P < 0.05 was defined as statistically significant.Results:1.A total of 109 patients with stage ? colorectal cancer were collected in this study,including 73 males and 36 females.There were 48 patients with > or = 60 years old,61 patients with < 60 years old,37 patients with right colon cancer,22 patients with left colon cancer and 50 patients with rectal cancer.Fifty-eight patients survived without disease for 5 years,40 with recurrence and metastasis,and 44 with death.The median survival time was 61.5 months,5-year DFS and OS were 53.1 and 59.6 percent,respectively.2.LNR have been determined by the ROC curve boundary value of 0.24,by chi-square test and Cox regression analysis results,the tumor pathological type LNR has influence in patients with colorectal cancer(P < 0.05),pathological types of mucous adenocarcinoma and signet ring cell carcinoma patients with stage ? colorectal cancer LNR is higher,the highest LNR signet ring cell carcinoma.3.The Kaplan Meier survival curve analysis and log-rank test found that tumor pathological type,differentiation degree,N staging,lymph node metastasis degree affect the prognosis of colorectal cancer was statistically significant(P < 0.05),and further multiariable Cox regression analysis found that tumor pathological type,differentiation degree,N staging,lymph node metastasis degree effect on the prognosis of colorectal cancer was statistically significant(P < 0.05)were independent risk factors;LNR(HR = 3.250;The predictive value of 95% CI: 1.644-6.427 for recurrence,metastasis or death of stage ? colorectal cancer was better than N staging(HR=2.987).95%ci: 1.528-5.839).4.According to the discriminant equation established by Cox multivariate regression analysis of inclusion factors,the equation for the discriminant function of survival status of stage ? colorectal cancer patients is:Y(0)=0.269 x pathological type +6.956 x degree of differentiation +5.601 x LNR+2.885 x n-10.472Y(1)=1.398 x pathological type +8.741 x degree of differentiation +7.122 x LNR+4.181 x n-18.655 * pathological type: 1= adenocarcinoma,2= mucinous adenocarcinoma,3= signet ring cell carcinoma;Degree of differentiation: 1= low level group,2= high level groupThe chi-square value of this discriminant function was 53.658,P < 0.001.The accuracy of judgment on the survival status of stage ? colorectal cancer patients was 78.9%.This equation was used to determine the survival rate of the survival group was 80.7%,and the survival rate of the tumor recurrence,metastasis or death group was 23.1%.After log-rank test analysis,there was a significant difference between the two groups,P=0.000.Conclusions:1.Tumor pathological type,differentiation degree,N stage and lymph node metastasis degree are independent risk factors influencing postoperative prognosis of stage ? colorectal cancer.2.Lymph node metastasis of 0.24,the sensitivity of LNR is 74.5%,specificity of 70.7%,can well predict the prognosis of patients with stage ? colorectal cancer,the detection of lymph node number more than 12 cases,to predict the phase ? colorectal cancer recurrence of postoperative metastasis or death LNR value than N staging.3.The multi-factor combined than single factor analysis can better judgment on the prognosis of patients with colorectal cancer,combined with tumor pathological type,tumor differentiation degree,N staging and LNR constructed discriminant equation can well predict the prognosis of patients with stage ? colorectal cancer,the accuracy is 78.9%.