Kutlu Onur C, Watchell Mitchell, Dissanaike Sharmila
Texas Tech University Health Sciences Center, Department of General Surgery, United States.
Texas Tech University Health Sciences Center, Department of Pathology, United States.
Surg Oncol. 2015 Jun;24(2):84-8. doi: 10.1016/j.suronc.2015.03.001. Epub 2015 Mar 24.
Lymph node positivity is a strong prognostic indicator in many cancers including gastric cancer. The extent of surgical resection directly influences the number of lymph nodes available for staging, with the lesser D1 resection that is standard practice in non-Asian countries typically providing fewer nodes for analysis. The widely used AJCC TNM staging system has been criticized for under-staging and stage migration where fewer than 15 nodes are resected, which is often the case in these populations. The ratio of positive to total nodes harvested--Lymph Node Ration (LNR)--has been proposed as an improved and more widely applicable prognostic indicator.
The LNR is a reliable and accurate prognostic indicator of survival in a Western gastric cancer population.
9357 patients were acquired via a SEER case listing session with 2004-2011 gastric adenocarcinoma diagnoses. AJCC 7th edition nodal staging (N0: 0, N1:1-2, N2:3-6, N3:≥7 positive lymph nodes) and LNR positive nodal staging (PN0: 0%, PN1: 1-20%, PN2: 21-50%, PN3: 51-100% of examined nodes positive) were compared as respects seven year survivorship.
Adjusted survival time ratios for AJCC nodal curves were less evenly distributed than were the percent positive nodal curves. Results of multiple regression reflected that survival time ratios of the percent positive nodal schema being more evenly spaced than those of the AJCC schema. Because BIC for AJCC, 41071.48, was larger than that for percent positive nodes, 41024.25, the LNR nodal system better explained survival than the AJCC nodal classification system.
LNR produced reliable and internally consistent survival curves for this population. LNR is an effective tool to predict survival in a western gastric cancer patient population, where the majority of the patients have limited lymph node dissection.
淋巴结阳性是包括胃癌在内的许多癌症的一个强有力的预后指标。手术切除范围直接影响可用于分期的淋巴结数量，在非亚洲国家作为标准术式的较小范围的D1切除通常提供较少的淋巴结用于分析。广泛使用的美国癌症联合委员会（AJCC）TNM分期系统因在切除少于15个淋巴结（这些人群中经常出现这种情况）时分期不足和分期迁移而受到批评。所获阳性淋巴结与总淋巴结的比值——淋巴结比率（LNR）——已被提议作为一种改进的、更广泛适用的预后指标。
LNR是西方胃癌人群生存的可靠且准确的预后指标。
通过监测、流行病学和最终结果（SEER）病例清单会议获取了9357例2004 - 2011年诊断为胃腺癌的患者。比较了AJCC第7版淋巴结分期（N0：0个，N1：1 - 2个，N2：3 - 6个，N3：≥7个阳性淋巴结）和LNR阳性淋巴结分期（PN0：0%，PN1：1 - 20%，PN2：21 - 50%，PN3：检查淋巴结的51 - 100%为阳性）的七年生存率。
AJCC淋巴结曲线的调整后生存时间比不如阳性淋巴结百分比曲线分布均匀。多元回归结果表明，阳性淋巴结百分比模式的生存时间比AJCC模式的生存时间比分布更均匀。因为AJCC的贝叶斯信息准则（BIC）为41071.48，大于阳性淋巴结百分比的BIC（41024.25），所以LNR淋巴结系统比AJCC淋巴结分类系统能更好地解释生存情况。
LNR为此人群生成了可靠且内部一致的生存曲线。LNR是预测西方胃癌患者人群生存的有效工具，该人群中的大多数患者淋巴结清扫范围有限。
