Wu Yulian, Chen Jian, Yu Junxiu, Gao Shunliang, Shen Hongwei
Department of Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, P. R. China.
J Surg Oncol. 2006 Jun 1;93(7):534-40. doi: 10.1002/jso.20559.
Current preoperative N staging does not offer an accurate estimation of lymph node involvement. We establish a new scoring system for predicting N stages to guide a rational lymphadenectomy for gastric cancer.
Variables correlated with N stages were selected by multivariate stepwise logistic regression analysis. Variables granted the different scores according to the odds ratio (OR). Receiver operating characteristic (ROC) analysis was used to generate scoring ranges from N0 to N3. The agreement between predicted N staging and actual pN classification was analyzed using kappa statistics.
Tumor size, depth of invasion, and histological types were selected to establish the scoring system. Scores 0-4, 5-7, 8-9, and 10-13 were postulated to predict N0-3, respectively. The predicted N stage has good agreement with the actual pN classifications. The negative predictive values for N0-3 were 87.0, 86.4, 90.4, and 90.2%; the positive predictive values were 74.7, 62.8, 57.3, and 69.6%, respectively. The accuracy is 82% for N0-1, and 83.7% for N2-3.
The new scoring system can predict the N stage of gastric cancer. With its good negative predictive value, it is possible to minimize the potential hazards of applying a more extensive lymph node dissection than necessary.
目前的术前N分期并不能准确估计淋巴结受累情况。我们建立一种新的评分系统来预测N分期，以指导合理的胃癌淋巴结清扫术。
通过多因素逐步逻辑回归分析选择与N分期相关的变量。根据比值比（OR）赋予变量不同的分数。采用受试者工作特征（ROC）分析得出从N0到N3的评分范围。使用kappa统计分析预测的N分期与实际pN分类之间的一致性。
选择肿瘤大小、浸润深度和组织学类型来建立评分系统。分别假定0 - 4分、5 - 7分、8 - 9分和10 - 13分预测N0 - 3期。预测的N分期与实际pN分类具有良好的一致性。N0 - 3期的阴性预测值分别为87.0%、86.4%、90.4%和90.2%；阳性预测值分别为74.7%、62.8%、57.3%和69.6%。N0 - 1期的准确率为82%，N2 - 3期的准确率为83.7%。
新的评分系统可以预测胃癌的N分期。因其良好的阴性预测值，有可能将应用比必要范围更广泛的淋巴结清扫术的潜在危害降至最低。
