Cao Jinlin, Yuan Ping, Ma Honghai, Ye Peng, Wang Yiqing, Yuan Xiaoshuai, Bao Feichao, Lv Wang, Hu Jian
Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Ann Thorac Surg. 2016 Aug;102(2):424-32. doi: 10.1016/j.athoracsur.2016.03.030. Epub 2016 May 13.
The number of lymph node metastases (LNMs) and the positive lymph node ratio (LNR) have been shown to be significant independent prognostic factors in predicting overall survival in patients with esophageal cancer. Our aim was to evaluate whether a novel prognostic indicator-the log odds of positive lymph nodes (LODDS)-predicts survival in esophageal cancer.
Patients who underwent esophagectomy for esophageal cancer between 1988 and 2007 were identified from the Surveillance, Epidemiology, and End Results (SEER) database of 18 registries, and a Chinese patient cohort was subjected to validation. The prognostic efficacy of LNM, LNR, and LODDS was compared. Prognostic performance was measured using Harrell's C-index statistic, Schemper's proportion of explained variation, and the Akaike information criterion (AIC).
A total of 4,123 patients in the SEER database and 134 patients in the Chinese cohort met our criteria in this study. LODDS gave a better prognostic performance than either LNM or LNR in both the SEER database and the Chinese cohort. Multivariate analyses showed significant values for LNM, LNR, and LODDS as prognostic factors (p < 0.001). However, only LODDS was a significant prognostic factor regardless of the number of lymph nodes retrieved (p = 0.677). Furthermore, after stratification of patients with no nodes involved or all nodes involved, the values of LODDS still distinguished the heterogeneity efficiently.
LODDS predicts survival more accurately than either LNM or LNR in patients undergoing resection for esophageal cancer, especially for patients with an insufficient number of lymph nodes retrieved.
淋巴结转移数量（LNMs）和阳性淋巴结比率（LNR）已被证明是预测食管癌患者总生存期的重要独立预后因素。我们的目的是评估一种新的预后指标——阳性淋巴结对数比值（LODDS）能否预测食管癌患者的生存期。
从18个登记处的监测、流行病学和最终结果（SEER）数据库中识别出1988年至2007年间因食管癌接受食管切除术的患者，并对一个中国患者队列进行验证。比较了LNMs、LNR和LODDS的预后效果。使用Harrell的C指数统计量、Schemper的解释变异比例和赤池信息准则（AIC）来衡量预后性能。
SEER数据库中的4123例患者和中国队列中的134例患者符合本研究的标准。在SEER数据库和中国队列中，LODDS的预后性能均优于LNMs或LNR。多因素分析显示，LNMs、LNR和LODDS作为预后因素具有显著意义（p<0.001）。然而，无论检出的淋巴结数量如何，只有LODDS是一个显著的预后因素（p = 0.677）。此外，在对无淋巴结受累或所有淋巴结受累的患者进行分层后，LODDS的值仍能有效区分异质性。
对于接受食管癌切除术的患者，尤其是检出淋巴结数量不足的患者，LODDS比LNMs或LNR更准确地预测生存期。
