Zhang Hongdian, Chen Chuangui, Yue Jie, Ma Mingquan, Ma Zhao, Yu Zhentao
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin 300060, China.
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin 300060, China. Email:
Zhonghua Zhong Liu Za Zhi. 2014 Feb;36(2):141-6.
To analyze the effects of number of positive lymph nodes and metastatic lymph node ratio (LNR) in evaluation of recurrence risk and overall survival in patients with adenocarcinoma of the esophagogastric junction (AEG) after curative resection.
Clinical data of 337 AEG patients who underwent curative resection in our hospital were retrospectively reviewed. The pN stage was categorized based on the number of metastatic lymph nodes and LNR stage, and was determined by the best cutoff approach at log-rank test. Univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model were used to analyze the effects of pN and LNR on recurrence-free survival and overall survival of these patients. Receiver operating characteristic (ROC) curves were plotted to compare the accuracy of prognosis prediction with pN and LNR.
The 5-year recurrence-free survival rate and overall survival rate for all patients were 25.5% and 29.9%, respectively. The 5-year recurrence-free survival rates were 47.6%, 23.2%, 17.1% and 5.7% for pN0, pN1, pN2, and pN3, respectively, (P < 0.001) and the 5-year overall survival rates were 53.3%, 28.9%, 18.9% and 7.3%, respectively (P < 0.001). The 5-year recurrence-free survival rates were 47.6%, 24.3%, 11.4% and 2.0% for LNR0, LNR1, LNR2, and LNR3, respectively (P < 0.001), and the 5-year overall survival rates were 53.3%, 28.5%, 15.0%, 2.6%, respectively (P < 0.001). Univariate analysis showed that tumor size, macroscopic type, degree of differentiation, pT, pN, LNR and TNM stage were significantly associated with RFS and OS (P < 0.05). Cox multivariate analysis showed that either pN or LNR was independent risk factor for RFS and OS (P < 0.001). When pN and LNR were entered into the Cox hazard ratio model as covariates at the same time, LNR remained as an independent prognosis factor for RFS and OS (P < 0.001), but pN was not (P > 0.05). ROC curves showed that the area under the curve of LNR stage was larger than that of pN stage in prediction of both RFS and OS, however the differences were not statistically significant (P > 0.05).
LNR is an independent risk factor associated with the prognosis of AEG patients. The value of LNR in prediction of recurrence hazard and overall survival was better than that of pN stage. It offers some helpful suggestions for AEG patients risk classification, allowing clinicians to develop a reasonable treatment.
分析阳性淋巴结数量和转移淋巴结比率（LNR）对食管胃交界腺癌（AEG）患者根治性切除术后复发风险及总生存期评估的影响。
回顾性分析我院337例行根治性切除的AEG患者的临床资料。根据转移淋巴结数量和LNR分期对pN分期进行分类，并通过对数秩检验的最佳截断点法确定。采用单因素Kaplan-Meier生存分析和多因素Cox比例风险模型分析pN和LNR对这些患者无复发生存期和总生存期的影响。绘制受试者工作特征（ROC）曲线以比较pN和LNR预测预后的准确性。
所有患者的5年无复发生存率和总生存率分别为25.5%和29.9%。pN0、pN1、pN2和pN3患者的5年无复发生存率分别为47.6%、23.2%、17.1%和5.7%（P<0.001），5年总生存率分别为53.3%、28.9%、18.9%和7.3%（P<0.001）。LNR0、LNR1、LNR2和LNR3患者的5年无复发生存率分别为47.6%、24.3%、11.4%和2.0%（P<0.001），5年总生存率分别为53.3%、28.5%、15.0%和2.6%（P<0.001）。单因素分析显示肿瘤大小、大体类型、分化程度、pT、pN、LNR和TNM分期与无复发生存期和总生存期显著相关（P<0.05）。Cox多因素分析显示pN和LNR均为无复发生存期和总生存期的独立危险因素（P<0.001）。当pN和LNR同时作为协变量纳入Cox风险比模型时，LNR仍是无复发生存期和总生存期的独立预后因素（P<0.001），而pN不是（P>0.05）。ROC曲线显示，在预测无复发生存期和总生存期方面，LNR分期的曲线下面积大于pN分期，但差异无统计学意义（P>0.05）。
LNR是与AEG患者预后相关的独立危险因素。LNR在预测复发风险和总生存期方面的价值优于pN分期。这为AEG患者的风险分类提供了一些有益的建议，有助于临床医生制定合理的治疗方案。
