State Key Laboratory of Oncology in South China, Guangzhou, China.
PLoS One. 2012;7(2):e31736. doi: 10.1371/journal.pone.0031736. Epub 2012 Feb 14.
In this study, we established a hypothetical tumor-lodds-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. Moreover, we compared them with the 7(th) edition of American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM) staging system in gastric cancer patients after D2 resection.
A total of 1000 gastric carcinoma patients receiving treatment in our center were selected for the analysis. Finally, 730 patients who received D2 resection were retrospectively studied. Patients were staged using the TLM, TRM and the 7(th) edition AJCC TNM system. Survival analysis was performed with a Cox regression model. We used two parameters to compare the TNM, TRM and TLM staging system, the -2log likelihood and the hazard ratio.
The cut points of lymph node ratio (LNR) were set as 0, 0-0.3, 0.3-0.6, 0.6-1.0. And for the log odds of positive lymph nodes (LODDS), the cut points were established as≤-0.5, -0.5-0, 0-0.5, >0.5. There were significant differences in survival among patients in different LODDS classifications for each pN or LNR groups. When stratified by the LODDS classifications, the prognosis was highly homologous between those in the according pN or LNR classifications. Multivariate analysis showed that TLM staging system was better than the TRM or TNM system for the prognostic evaluation.
The TLM system was superior to the TRM or TNM system for prognostic assessment of gastric adenocarcinoma patients after D2 resection.
本研究建立了假设的肿瘤-淋巴结-转移（TLM）和肿瘤比-转移（TRM）分期系统，并与接受 D2 切除的胃癌患者的第 7 版美国癌症联合委员会肿瘤-淋巴结-转移（AJCC TNM）分期系统进行了比较。
共选取 1000 例在本中心接受治疗的胃癌患者进行分析，最终回顾性研究了 730 例接受 D2 切除的患者。采用 TLM、TRM 和第 7 版 AJCC TNM 系统对患者进行分期，采用 Cox 回归模型进行生存分析。我们使用两个参数来比较 TNM、TRM 和 TLM 分期系统，即 -2log 似然比和危险比。
将淋巴结比率（LNR）的切点设定为 0、0-0.3、0.3-0.6、0.6-1.0，对数阳性淋巴结（LODDS）的切点设定为≤-0.5、-0.5-0、0-0.5、>0.5。不同 LODDS 分类的患者在每个 pN 或 LNR 组中的生存情况存在显著差异。当按 LODDS 分类分层时，相应的 pN 或 LNR 分类之间的预后具有高度同质性。多变量分析显示，TLM 分期系统在预后评估方面优于 TRM 或 TNM 系统。
TLM 系统在评估接受 D2 切除的胃腺癌患者的预后方面优于 TRM 或 TNM 系统。
