左半结肠癌第253组淋巴结转移的临床意义

  目的  探讨左半结肠癌第253组淋巴结转移及清扫的临床价值。  方法  回顾性收集2009年1月至2015年12月于海南医学院第二附属医院和海南医学院第一附属医院收治的629例左半结肠癌患者的临床病理资料，分析影响第253组淋巴结转移的临床病理因素及其与预后的关系。  结果  629例患者中58例（9.2%）有第253组淋巴结转移。肿瘤部位、pT分期、pN分期、癌结节、脉管癌栓和术前CA19-9水平与第253组淋巴结转移独立相关。分层分析显示，第253组淋巴结转移对pN1、pN2a和pN2b期患者预后影响均具有统计学意义。单因素生存分析显示，Ⅲ期左半结肠癌第253组淋巴结转移和未转移患者5年生存率分别为25.9%和65.0%，差异具有统计学意义（P<0.001）。倾向匹配后进行多因素生存分析，证实第253组淋巴结转移是Ⅲ期左半结肠癌患者的独立预后因素（HR=1.474，95%CI:1.072～2.498；P=0.037）。  结论  第253组淋巴结转移是Ⅲ期左半结肠癌患者的独立预后因素，第253组淋巴结状态对肿瘤分期、预后评估具有重要意义，存在该组淋巴结转移的患者预后不良。 

Clinical significance of No.253 lymph node metastasis in left hemi-colon cancer

  Objective  To investigate the clinical value of No.253 lymph node metastasis and dissection in left hemi-colon cancer.   Methods  A total of 629 patients with left hemi-colon cancer from The Second Affiliated Hospital and The First Affiliated Hospital of Hainan Medical University, between January 2009 and December 2015, were enrolled. Clinicopathological factors correlating with No.253 lymph node metastasis and potential prognostic factors were analyzed.   Results  Fifty-eight (9.2%) patients had No.253 lymph node metastases. In multivariate analyses, tumor location, pT stage, pN stage, extranodal tumor deposits, lymphovascular invasion, and preoperative CA19-9 levels were independent risk factors for No.253 lymph node metastasis. Stratified analyses revealed that No.253 lymph node metastasis had a negative impact on overall survival in patients with pN1, pN2a, and pN2b stage disease. Five-year overall survival rates were 25.9% and 65.0% for those with stage Ⅲ disease with and without No.253 lymph node metastasis, respectively, and the survival difference was significant (P <0.001). After propensity score matching, multivariate survival analysis confirmed that No.253 lymph node metastasis was an independent prognostic factor in patients with stage Ⅲ left hemi-colon cancer (HR=1.474, 95%CI:1.072-2.498; P=0.037).   Conclusions  No.253 lymph node metastasis was an independent prognostic factor in patients with stage Ⅲ left hemi-colon cancer. The status of the No.253 lymph node plays an important role in stage and prognosis evaluations. Patients with No.253lymph node metastasis had a poorer prognosis.