胃腺癌根治性切除术后不同淋巴结分期系统的预后性能
Prognostic Performance of Different Lymph Node Staging Systems After Curative Intent Resection for Gastric Adenocarcinoma.
作者信息
Spolverato Gaya, Ejaz Aslam, Kim Yuhree, Squires Malcolm H, Poultsides George, Fields Ryan C, Bloomston Mark, Weber Sharon M, Votanopoulos Konstantinos, Acher Alexandra W, Jin Linda X, Hawkins William G, Schmidt Carl, Kooby David A, Worhunsky David, Saunders Neil, Cho Clifford S, Levine Edward A, Maithel Shishir K, Pawlik Timothy M
机构信息
*Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD †Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA ‡Department of Surgery, Stanford University, Palo Alto, CA §Department of Surgery, Washington University School of Medicine, St. Louis, MO ¶Department of Surgery, The Ohio State University, Columbus, OH ||Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI **Department of Surgery, Wake Forest University, Winston-Salem, NC.
出版信息
Ann Surg. 2015 Dec;262(6):991-8. doi: 10.1097/SLA.0000000000001040.
OBJECTIVE
To compare the prognostic performance of American Joint Committee on Cancer/International Union Against Cancer seventh N stage relative to lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS), and N score in gastric adenocarcinoma.
BACKGROUND
Metastatic disease to the regional LN basin is a strong predictor of worse long-term outcome following curative intent resection of gastric adenocarcinoma.
METHODS
A total of 804 patients who underwent surgical resection of gastric adenocarcinoma were identified from a multi-institutional database. The relative discriminative abilities of the different LN staging/scoring systems were assessed using the Akaike's Information Criterion (AIC) and the Harrell's concordance index (c statistic).
RESULTS
Of the 804 patients, 333 (41.4%) had no lymph node metastasis, whereas 471 (58.6%) had lymph node metastasis. Patients with ≥N1 disease had an increased risk of death (hazards ratio = 2.09, 95% confidence interval: 1.68-2.61; P < 0.001]. When assessed using categorical cutoff values, LNR had a somewhat better prognostic performance (C index: 0.630; AIC: 4321.9) than the American Joint Committee on Cancer seventh edition (C index: 0.615; AIC: 4341.9), LODDS (C index: 0.615; AIC: 4323.4), or N score (C index: 0.620; AIC: 4324.6). When LN status was modeled as a continuous variable, the LODDS staging system (C index: 0.636; AIC: 4304.0) outperformed other staging/scoring systems including the N score (C index: 0.632; AIC: 4308.4) and LNR (C index: 0.631; AIC: 4225.8). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that was better stratified and characterized by the LODDS.
CONCLUSIONS
When assessed as a categorical variable, LNR was the most powerful manner to stratify patients on the basis of LN status. LODDS was a better predicator of survival when LN status was modeled as a continuous variable, especially among those patients with either very low or high LNR.
目的
比较美国癌症联合委员会/国际抗癌联盟第七版N分期相对于淋巴结比率（LNR）、转移淋巴结对数优势比（LODDS）和N评分在胃腺癌中的预后性能。
背景
区域淋巴结转移是胃腺癌根治性切除术后长期预后较差的有力预测指标。
方法
从一个多机构数据库中识别出804例行胃腺癌手术切除的患者。使用赤池信息准则（AIC）和哈雷尔一致性指数（c统计量）评估不同淋巴结分期/评分系统的相对判别能力。
结果
804例患者中，333例（41.4%）无淋巴结转移，471例（58.6%）有淋巴结转移。≥N1期疾病患者的死亡风险增加（风险比=2.09，95%置信区间：1.68-2.61；P<0.001）。当使用分类临界值评估时，LNR的预后性能（C指数：0.630；AIC：4321.9）比美国癌症联合委员会第七版（C指数：0.615；AIC：4341.9）、LODDS（C指数：0.615；AIC：4323.4）或N评分（C指数：0.620；AIC：4324.6）稍好。当将淋巴结状态建模为连续变量时，LODDS分期系统（C指数：0.636；AIC：4304.0）优于其他分期/评分系统，包括N评分（C指数：0.632；AIC：4308.4）和LNR（C指数：0.631；AIC：4225.8）。在LNR评分为0或1的患者中，存在结果的残余异质性，LODDS能更好地对其进行分层和特征描述。
结论
当作为分类变量评估时，LNR是根据淋巴结状态对患者进行分层的最有效方式。当将淋巴结状态建模为连续变量时，LODDS是更好的生存预测指标，尤其是在LNR非常低或非常高的患者中。
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