演題

RS1-26-12-6

大腸癌手術の郭清個数分類ー病期,予後予測,手術の質に関連して

[演者] 橋口 陽二郎:1
[著者] 松田 圭二:1, 野澤 慶次郎:1, 土屋 剛史:1, 岡本 耕一:1, 端山 軍:1, 島田 竜:1, 赤羽根 拓弥:1, 福島 慶久:1, 塚本 充雄:1
1:帝京大学附属病院 外科

【Background】The implication of the total number of LNs examined (NLNE) involves three major aspects of clinical care: staging, prognosis, and quality control.
【Object】The purpose of the study is to identify universal cutoff points for colon cancer using large multicenter cohort in the United States (Surveillance Epidemiology and End Results; SEER) to suggest a clinically useful classification of NLNE.
【Patients and Methods】The data from the SEER on 39,210 patients, with T3 and T4 colon cancer without distant metastasis, who underwent radical surgery and were diagnosed from 1988 to 2001, were analyzed due to the consistency of data descriptions and sufficient follow-up periods during this time. The cutoff points for NLNE were analyzed using a joinpoint analysis, martingale residual plots analysis, and Harrell's c-index.
【Results】The distribution of the NLNE was characterized with a median of 11.0, and mean of 12.6. A steep peak of the frequency was formed between 5 and 8. There was a significant increment in the NLNE from 11.5 at 1988 to 14.0 at 2001 (p<0.0001). The minimal NLNE required for accurate staging by joinpoint analysis was 8. The c-index showed one relatively flat peak continuing from NLNE at 11 to 13. According to these results, we defined NE category and classified patients into 4 categories by NLNE; Category A (20≦), B (12-19), C (8-11) and D (1-7). The number and proportion of patients classified to Category A, B, C, and D were 6601 (16.8%), 11257 (28.7%), 8988 (22.9%), and 12364 (31.5%). The 5-year overall survival of patients significantly declined in all stages from Category A to D (p<0.0001). The most remarkable changes were observed in Stage IIC patients. The 5-year overall survival decreased from 66.1% in Category A to 32.7% in Category D (p<0.0001).
【Conclusions】The NE category may be a useful tool as both a prognostic indicator and as a quality care measure for colon cancer surgery, which may contribute to tailor-made treatments.
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