Conci S, Ruzzenente A, Sandri M, Bertuzzo F, Campagnaro T, Bagante F, Capelli P, D'Onofrio M, Piccino M, Dorna A E, Pedrazzani C, Iacono C, Guglielmi A
Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy.
Department of Economics and Management, Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy.
Eur J Surg Oncol. 2017 Apr;43(4):743-750. doi: 10.1016/j.ejso.2016.12.007. Epub 2017 Jan 8.
We compared the prognostic performance of the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) 7th edition pN stage, number of metastatic LNs (MLNs), LN ratio (LNR), and log odds of MLNs (LODDS) in patients with perihilar cholangiocarcinoma (PCC) undergoing curative surgery in order to identify the best LN staging method.
Ninety-nine patients who underwent surgery with curative intent for PCC in a single tertiary hepatobiliary referral center were included in the study. Two approaches were used to evaluate and compare the predictive power of the different LN staging methods: one based on the estimation of variable importance with prediction error rate and the other based on the calculation of the receiver operating characteristic (ROC) curve.
LN dissection was performed in 92 (92.9%) patients; 49 were UICC/AJCC pN0 (49.5%), 33 pN1 (33.3%), and 10 pN2 (10.1%). The median number of LNs retrieved was 8. The prediction error rate ranged from 42.7% for LODDS to 47.1% for UICC/AJCC pN stage. Moreover, LODDS was the variable with the highest area under the ROC curve (AUC) for prediction of 3-year survival (AUC = 0.71), followed by LNR (AUC = 0.60), number of MLNs (AUC = 0.59), and UICC/AJCC pN stage (AUC = 0.54).
The number of MLNs, LNR, and LODDS appear to better predict survival than the UICC/AJCC pN stage in patients undergoing curative surgery for PCC. Moreover, LODDS seems to be the most accurate and predictive LN staging method.
我们比较了国际抗癌联盟/美国癌症联合委员会（UICC/AJCC）第7版pN分期、转移淋巴结（MLN）数量、淋巴结比率（LNR）以及MLN对数优势比（LODDS）在接受根治性手术的肝门部胆管癌（PCC）患者中的预后评估性能，以确定最佳的淋巴结分期方法。
本研究纳入了在一家三级肝胆转诊中心接受PCC根治性手术的99例患者。采用两种方法评估和比较不同淋巴结分期方法的预测能力：一种基于预测错误率估计变量重要性，另一种基于计算受试者工作特征（ROC）曲线。
92例（92.9%）患者进行了淋巴结清扫；49例为UICC/AJCC pN0（49.5%），33例为pN1（33.3%），10例为pN2（10.1%）。回收淋巴结的中位数为8个。预测错误率范围从LODDS的42.7%到UICC/AJCC pN分期的47.1%。此外，对于3年生存率预测，LODDS是ROC曲线下面积（AUC）最高的变量（AUC = 0.71），其次是LNR（AUC = 0.60）、MLN数量（AUC = 0.59）和UICC/AJCC pN分期（AUC = 0.54）。
在接受PCC根治性手术的患者中，MLN数量、LNR和LODDS似乎比UICC/AJCC pN分期能更好地预测生存。此外，LODDS似乎是最准确且具有预测性的淋巴结分期方法。
