Huang Ben, Ni Mengdong, Chen Chen, Cai Guoxiang, Cai Sanjun
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai - People's Republic of China.
Tumori. 2017 Jan 21;103(1):87-92. doi: 10.5301/tj.5000560. Epub 2016 Oct 3.
Yielding pathologic-lymph node ratio (yp-LNR) was considered to be a better staging system than yp-N stage in rectal cancer patients treated with preoperative radiotherapy (pre-RT). We aimed to compare the predictive ability of yielding pathologic log odds of positive lymph nodes (yp-LODDS) with that of yp-LNR for cancer-specific survival (CSS) in stage III rectal cancer patients treated with pre-RT.
We analyzed stage III rectal cancer patients treated with pre-RT in the Surveillance, Epidemiology and End Results (SEER) database. Patients were classified into 4 groups, yp-LNR1 to 4, based on the LNR cutoff points 0.25, 0.50, and 0.75. Subjects were categorized into 5 groups, yp-LODDS1 to yp-LODDS5, based on the LODDS cutoff points -1, 0, 1, and 2. Univariate and multivariate Cox proportional hazards models were performed to analyze the risk factors for survival outcome.
A total of 4,612 patients were included from the SEER database. Patients in the yp-LNR4 group could be further divided into yp-LODDS4 and yp-LODDS5 groups with 5-year CSS of 47.6% and 31.5%, respectively (p<0.001). In the multivariate analysis without yp-LODDS, yp-LNR was an independent prognostic factor (hazard ratio [HR] 2.006, 95% confidence interval [CI] 1.619-2.484, p<0.001). However, after adjusting for yp-LODDS, yp-LNR was no longer associated with CSS (p = 0.393), and yp-LODDS was identified as an independent prognostic factor (HR 1.274, 95% CI 1.069-1.520, p = 0.007).
The prognostic value of yp-LNR can be confounded by yp-LODDS. In stage III rectal cancer patients treated with pre-RT, yp-LODDS has superior discrimination power over yp-LNR and can more accurately evaluate CSS.
在接受术前放疗（pre-RT）的直肠癌患者中，病理淋巴结产出率（yp-LNR）被认为是比yp-N分期更好的分期系统。我们旨在比较在接受pre-RT的III期直肠癌患者中，阳性淋巴结病理对数优势比（yp-LODDS）与yp-LNR对癌症特异性生存（CSS）的预测能力。
我们分析了监测、流行病学和最终结果（SEER）数据库中接受pre-RT的III期直肠癌患者。根据LNR截断点0.25、0.50和0.75，将患者分为4组，即yp-LNR1至4组。根据LODDS截断点-1、0、1和2，将受试者分为5组，即yp-LODDS1至yp-LODDS5组。采用单因素和多因素Cox比例风险模型分析生存结局的危险因素。
SEER数据库共纳入4612例患者。yp-LNR4组患者可进一步分为yp-LODDS4组和yp-LODDS5组，5年CSS分别为47.6%和31.5%（p<0.001）。在无yp-LODDS的多因素分析中，yp-LNR是独立的预后因素（风险比[HR]2.006，95%置信区间[CI]1.619-2.484，p<0.001）。然而，在调整yp-LODDS后，yp-LNR与CSS不再相关（p = 0.393），yp-LODDS被确定为独立的预后因素（HR 1.274，95%CI 1.069-1.520，p = 0.007）。
yp-LNR的预后价值可能会被yp-LODDS混淆。在接受pre-RT的III期直肠癌患者中，yp-LODDS比yp-LNR具有更好的区分能力，并且能够更准确地评估CSS。
