Calero A, Escrig-Sos J, Mingol F, Arroyo A, Martinez-Ramos D, de Juan M, Salvador-Sanchis J L, Garcia-Granero E, Calpena R, Lacueva F J
Department of General and Digestive Surgery, Hospital General Universitario, Cami de l'Almazara 11, 03203, Elche, Spain,
J Gastrointest Surg. 2015 May;19(5):813-20. doi: 10.1007/s11605-014-2728-5. Epub 2015 Jan 6.
The lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) have been proposed to minimize the stage migration phenomenon. The value of the LODDS and LNR staging systems to predict and discriminate prognosis was assessed and compared to the International Union Against Cancer (UICC) TNM classification (pN).
Three hundred and twenty-six patients with gastric carcinoma were retrospectively studied. Disease-specific survival rates were calculated for every pN, LNR, and LODDS category.
Four LNR categories (0, 1-25, 26-75, and >76 %) and four LODDS categories (-5 to -3, > -3 to -1, > -1 to 3, and >3 to 5) were established. In the multivariate analysis, only the stage pT3-4 versus pT1-2 (HR 1.88, 95 % CI 1.11-3.20, p=0.02) and LODDS as continuous variable (HR 1.40, 95 % CI 1.21-1.61, p<0.001) remained as independent prognostic factors. In patients with <16 lymph nodes retrieved, only the LODDS system could discriminate different disease-specific survival curves for every category. LODDS categories were able to discriminate subgroups with different prognoses in pN stages and LNR categories.
The LODDS staging system was superior to the pN classification and LNR system to discriminate risk prognosis especially in patients with an insufficient number of retrieved lymph nodes.
已提出淋巴结比率（LNR）和阳性淋巴结对数比值（LODDS）以尽量减少分期迁移现象。评估了LODDS和LNR分期系统预测和区分预后的价值，并与国际抗癌联盟（UICC）TNM分类（pN）进行比较。
对326例胃癌患者进行回顾性研究。计算每个pN、LNR和LODDS类别的疾病特异性生存率。
建立了四个LNR类别（0、1 - 25、26 - 75和>76%）和四个LODDS类别（-5至-3、>-3至-1、>-1至3和>3至5）。在多变量分析中，只有pT3 - 4期与pT1 - 2期（HR 1.88，95%CI 1.11 - 3.20，p = 0.02）以及作为连续变量的LODDS（HR 1.40，95%CI 1.21 - 1.61，p < 0.001）仍然是独立的预后因素。在切除淋巴结少于16个的患者中，只有LODDS系统能够区分每个类别的不同疾病特异性生存曲线。LODDS类别能够区分pN分期和LNR类别中具有不同预后的亚组。
LODDS分期系统在区分风险预后方面优于pN分类和LNR系统，尤其是在切除淋巴结数量不足的患者中。
