Zhang Hong-dian, Ma Zhao, Tang Peng, Duan Xiao-feng, Ren Peng, Yue Jie, Yu Zhen-tao
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2013 Sep;16(9):822-6.
To compare the prognostic value of AJCC/UICC pN stage with metastatic lymph node ratio (MLR) and the prognostic difference between the tumor-node-metastasis (TNM) stage and tumor-ratio-metastasis (TRM) stage in patients with adenocarcinoma of the gastroesophageal junction.
Clinical data of 414 patients with adenocarcinoma of the gastroesophageal junction undergoing curative resection at the Tianjin Medical University Cancer Institute and Hospital from January 2000 to June 2007 were retrospectively reviewed. Spearman correlation analysis was performed to examine the correlations between pN, MLR and retrieved nodes. Univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis were performed to analyze the effects of pN, MLR, TNM and TRM stage on the prognosis of these patients. The area under the ROC curve (AUC) was plotted to compare the value of these stages and to predict the 5-year survival rate.
The median number of retrieved nodes was 17 (4-71) per patient, and the median number of positive nodes was 4 (0-67) per patient. The number of metastatic lymph node was positively correlated with that of retrieved nodes (P<0.01), but MLR was not correlated with the number of retrieved nodes (P>0.05). Univariate and multivariate survival analysis showed that either pN or MLR could be used as an independent risk factor for survival (P<0.01) and the hazard ratio of MLR stage was larger than that of pN stage (1.573 vs 1.382). While pN and MLR were entered into the Cox hazard ratio model as covariates at the same time, MLR remained as the independent prognostic factor (P<0.01), but pN lost significance (P>0.05). The AUC of MLR and pN staging was 0.726 and 0.714, and of TRM and TNM staging was 0.747 and 0.736, respectively, however the differences were not statistically significant (all P>0.05).
MLR is an independent prognostic factor for patients with adenocarcinoma of the gastroesophageal junction. The value of MLR and TRM staging systems may be superior to pN and TNM staging systems in evaluating the prognosis of these patients.
比较美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）的pN分期与转移淋巴结比率（MLR）对胃食管交界腺癌患者的预后价值，以及肿瘤-淋巴结-转移（TNM）分期与肿瘤-比率-转移（TRM）分期之间的预后差异。
回顾性分析2000年1月至2007年6月在天津医科大学肿瘤医院接受根治性切除的414例胃食管交界腺癌患者的临床资料。采用Spearman相关性分析检验pN、MLR与回收淋巴结之间的相关性。进行单因素Kaplan-Meier生存分析和多因素Cox比例风险模型分析，以分析pN、MLR、TNM和TRM分期对这些患者预后的影响。绘制ROC曲线下面积（AUC）以比较这些分期的价值并预测5年生存率。
每位患者回收淋巴结的中位数为17个（4 - 71个），阳性淋巴结的中位数为4个（0 - 67个）。转移淋巴结数量与回收淋巴结数量呈正相关（P<0.01），但MLR与回收淋巴结数量无相关性（P>0.05）。单因素和多因素生存分析表明，pN或MLR均可作为生存的独立危险因素（P<0.01），且MLR分期的风险比大于pN分期（1.573对1.382）。当pN和MLR同时作为协变量纳入Cox风险比模型时，MLR仍为独立预后因素（P<0.01），但pN失去显著性（P>0.05）。MLR和pN分期的AUC分别为0.726和0.714，TRM和TNM分期的AUC分别为0.747和0.736，但差异无统计学意义（均P>0.05）。
MLR是胃食管交界腺癌患者的独立预后因素。在评估这些患者的预后方面，MLR和TRM分期系统的价值可能优于pN和TNM分期系统。
