摘要
Background:The risk of lymph-node metastasis(LNM)in T1 colorectal cancer(CRC)has not been well documented in heterogeneous Western populations.This study investigated the predictors of LNM and the long-term outcomes of patients by analysing T1 CRC surgical specimens and patients’demographic data.Methods:Patients with surgically resected T1 CRC between 2004 and 2014 were identified from the Surveillance,Epidemiology,and End Results(SEER)database.Patients with multiple primary cancers,with neoadjuvant therapy,or without a confirmed histopathological diagnosis were excluded.Multivariate logistic-regression analysis was used to identify the predictors of LNM.Results:Of the 22,319 patients,10.6%had a positive lymph-node status based on the final pathology(nodal category:N19.6%,N21.0%).Younger age,female sex,Asian or African-American ethnicity,poor differentiation,and tumor site outside the rectum were significantly associated with LNM.Subgroup analyses for patients stratified by tumor site suggested that the rate of positive lymph-node status was the lowest in the rectum(hazard ratio:0.74;95%confidence interval:0.63–0.86).Conclusion:The risk of LNM was potentially lower in Caucasian patients than in API or African-American patients with surgically resected T1 CRC.Regarding the T1 CRC site,the rectum was associated with a lower risk of LNM.
背景:在西方人群中,T1期结直肠癌患者的淋巴结转移风险尚未被充分报道。本研究通过对T1期CRC患者的手术标本和人口学资料进行分析,探讨淋巴结转移的预测因素及患者的长期预后。方法:从SEER数据库中筛选出2004-2014年间行手术切除的T1期结直肠癌患者,排除多原发癌、接受新辅助治疗或无病理诊断者。采用多因素逻辑回归分析确定淋巴结转移的预测因素。结果:22,319例T1期结直肠癌患者淋巴结转移率为10.6%,其中N1期9.6%,N2期1.0%。低龄、女性、亚裔或非裔美国人、低分化癌和肿瘤位于直肠以外者,淋巴结转移率显著增高。在不同部位的肿瘤中,直肠癌淋巴结转移率最低(HR=0.74;95%CI 0.63–0.86)。结论:对于T1期结直肠癌患者,美国白人的淋巴结转移风险较亚裔或非裔美国人更低;直肠癌患者淋巴结转移风险较其他部位肿瘤更低。
基金
supported by the National Natural Science Foundation of China[grant numbers 81860433,81860466]
the Guangdong Provincial Science and Technology Plan and Jiangxi Provincial Science and Technology Plan[grant numbers 2017A020215036,20192BAB215036]
the National Natural Science Foundation of China[Grant Number:81860433]
Training Plan for Academic and Technical Young Leaders of Major Disciplines in Jiangxi Province[Grant Number:20204BCJ23021]
the Key Technology Research and Development Program of Jiangxi Province[Grant Number:20202BBG73024]
the Foundation for Fostering Young Scholar of Nanchang Universiy[Grant Number:PY201822].
作者简介
Corresponding authors:Cheng-Hao Yi,Department of General Surgery,the Second Affiliated Hospital of Nanchang University,No.1 Minde Road,Donghu,Nanchang,Jiangxi 330006,P.R.China.Tel:t86-18170869861,Email:yichenghao-ncu@hotmail.com;Corresponding authors:Tai-Cheng Zhou,Department of Gastroenterological Surgery and Hernia Center,the Sixth Affiliated Hospital of Sun Yat-sen University,No.26 Yuancun Erheng Road,Tianhe,Guangzhou,Guangdong 510655,P.R.China.Tel:t86-13631466079,Email:zhoutch3@mail.sysu.edu.cn.
