Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China.
Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China.
J Thorac Oncol. 2016 Oct;11(10):1774-84. doi: 10.1016/j.jtho.2016.06.019. Epub 2016 Jul 5.
The seventh edition of the TNM staging system for esophageal cancer outlined by the American Joint Committee on Cancer (AJCC) defines the N classification on the basis of the number of metastatic lymph nodes. However, this classification is dependent on the actual number of examined lymph nodes. Here in this study, we have focused on revising this N classification system with the metastatic lymph nodes ratio (LNR) and also assessing whether this modification to the current AJCC staging system can better define the prognostic characteristics of esophageal squamous cell carcinoma (ESCC).
We retrospectively reviewed 916 patients with ESCC who underwent curative resection. Prognostic performance of two staging systems was compared using the Akaike information criterion value and receiver operating characteristics curve. In addition, decision curve analysis evaluated the clinical practical usefulness of the prediction models by quantifying their net benefits.
The univariate and multivariate Cox regression analyses indicated that LNR was an independent risk factor for overall survival. The modified staging system based on LNR had better discriminatory ability, monotonicity, homogeneity, and stratification than the TNM staging system in determining the prognosis of patients with ESCC. However, the decision curves analysis suggested that the modified staging based on LNR has poor clinical practical value over the AJCC TNM staging system.
LNR can supplement the pN categorization system for more effective evaluation of prognosis. But the modified staging system based on LNR has a poor clinical practical value for patients with ESCC compared with the current TNM system and is not superior to AJCC pN staging for ESCC.
美国癌症联合委员会（AJCC）制定的第七版食管癌 TNM 分期系统将 N 分类定义为基于转移淋巴结数量。然而，这种分类依赖于实际检查的淋巴结数量。在本研究中，我们专注于用转移淋巴结比（LNR）来修正这个 N 分类系统，并评估这种对当前 AJCC 分期系统的修正是否可以更好地定义食管鳞状细胞癌（ESCC）的预后特征。
我们回顾性分析了 916 例接受根治性切除术的 ESCC 患者。通过 Akaike 信息准则值和接收者操作特征曲线比较了两种分期系统的预后性能。此外，决策曲线分析通过量化预测模型的净收益来评估预测模型的临床实用价值。
单因素和多因素 Cox 回归分析表明，LNR 是总生存的独立危险因素。基于 LNR 的改良分期系统在确定 ESCC 患者的预后方面，比 TNM 分期系统具有更好的区分能力、单调性、同质性和分层性。然而，决策曲线分析表明，基于 LNR 的改良分期系统在临床实用价值方面逊于 AJCC TNM 分期系统。
LNR 可以补充 pN 分类系统，以更有效地评估预后。但是，与当前的 TNM 系统相比，基于 LNR 的改良分期系统对 ESCC 患者的临床实用价值较差，并且在评估 ESCC 方面并不优于 AJCC pN 分期。
