Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
Ann Surg Oncol. 2013 May;20(5):1653-9. doi: 10.1245/s10434-012-2794-4. Epub 2012 Dec 18.
BACKGROUND: Controversy exists concerning the optimal cutoff points for the positive lymph node ratio (PLNR) to predict overall survival. We aim to propose reasonable PLNR categories for the discrimination of the survival difference between groups. METHODS: We used data from two centers to establish a training (n = 1006) and a validation (n = 783) cohort. All of the patients underwent curative surgical treatment. Martingale residuals from a Cox proportional hazards regression model were used to determine the optimal cutoff points for PLNR to predict overall survival. The survival rate was calculated using the Kaplan-Meier method, and a log-rank test was used to assess the survival differences between groups. The results obtained from the training cohort were tested with the validation cohort at each step. RESULTS: We classified the patients into four revised nodal categories: R-pN0 (PLNR = 0), R-pN1 (0< PLNR ≤0.1), R-pN2 (0.1< PLNR ≤0.3), and R-pN3 (PLNR >0.3). Subgroup analysis for the pT2 and pT3 cases showed that the survival differences could be well discriminated between groups based on PLNR in both the training cohort and validation cohort. When we modified the current staging system using revised nodal categories (based on PLNR) instead of the AJCC nodal categories, the survival rate could also be easily distinguished between patients in different stages in both cohorts of patients. CONCLUSIONS: The survival rate of ESCC can be discriminated between four groups: PLNR = 0, 0< PLNR ≤0.1, 0.1< PLNR ≤0.3, and PLNR >0.3. Further studies are required to confirm these results.
背景:关于阳性淋巴结比率(PLNR)预测总生存的最佳截断点存在争议。我们旨在提出合理的 PLNR 分类,以区分组间生存差异。
方法:我们使用来自两个中心的数据建立了一个训练(n = 1006)和一个验证(n = 783)队列。所有患者均接受根治性手术治疗。使用 Cox 比例风险回归模型的 Martingale 残差来确定 PLNR 预测总生存的最佳截断点。使用 Kaplan-Meier 方法计算生存率,并使用对数秩检验评估组间生存差异。在每个步骤中,我们都使用验证队列测试从训练队列获得的结果。
结果:我们将患者分为四个修订的淋巴结分类:R-pN0(PLNR = 0)、R-pN1(0<PLNR ≤0.1)、R-pN2(0.1<PLNR ≤0.3)和 R-pN3(PLNR >0.3)。对于 pT2 和 pT3 病例的亚组分析表明,基于 PLNR,在训练队列和验证队列中,都可以很好地区分组间的生存差异。当我们使用修订的淋巴结分类(基于 PLNR)而不是 AJCC 淋巴结分类修改当前分期系统时,在两个患者队列中,不同分期的患者的生存率也可以很容易地区分。
结论:ESCC 的生存率可以分为四组:PLNR = 0、0<PLNR ≤0.1、0.1<PLNR ≤0.3 和 PLNR >0.3。需要进一步的研究来证实这些结果。
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