阳性淋巴结的对数比值是手术切除后晚期食管鳞癌的一种新型预后指标。
Log odds of positive lymph nodes is a novel prognostic indicator for advanced ESCC after surgical resection.
作者信息
Yang Mingjian, Zhang Hongdian, Ma Zhao, Gong Lei, Chen Chuangui, Ren Peng, Shang Xiaobin, Tang Peng, Jiang Hongjing, Yu Zhentao
机构信息
Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
出版信息
J Thorac Dis. 2017 May;9(5):1182-1189. doi: 10.21037/jtd.2017.03.187.
BACKGROUND
To investigate the prognostic value of the log odds of positive lymph nodes (LODDS) in patients with advanced esophageal squamous cell carcinoma (ESCC) after surgical resection.
METHODS
Clinical data of 260 patients with advanced ESCC undergoing surgical resection were retrospectively reviewed. Univariate and multivariate analysis were done using the chi-square test and Cox regression model. Receiver-operating-characteristic (ROC) curve was used to compare the association of pathologic nodal (pN) and LODDS with 3- or 5-year overall survival (OS). The cut-point analyses were performed to determine whether there was a cutoff LODDS related to the greatest OS difference.
RESULTS
The mean follow-up duration was 30 months (range, 3 to 106 months). The 1-, 3-, 5-year OS rates were 70.0%, 41.9% and 30.3%, respectively. Univariate analyses indicated that the 5-year OS rates were 51.2%, 30.5%, 24.6%, and 14.2% in LODDS1, LODDS2, LODDS3, and LODDS4, respectively, and the median survival times were 68.7, 34.6, 24.0, and 14.6 months, respectively (P=0.000) for all patients, and subgroup analysis showed the effect did not change in 155 patients without lymph node (LN) metastasis (P=0.024). Multivariate analysis showed that LODDS [hazard ratio (HR) =1.309, P=0.003] to be independent and significant prognostic factors for all patients, so as in node-negative patients LODDS (HR =1.610, P=0.038). The AUC of LODDS stage (AUC =0.630) was larger than that of pN stage (AUC =0.621) in prediction of 3-year OS, however LODDS were smaller in prediction of 5-year OS (AUC =0.620, 0.631, respectively), and the differences were not statistically significant (P>0.05 all). Lastly, the step analysis identified the best cut-off point for LODDS as -1.2 that is significantly associated with the prognosis of the node-negative patients (P=0.024), and the ROC analysis also indicated that a cut-off value of -1.2 for LODDS provided the highest sensitivity and specificity interestingly.
CONCLUSIONS
LODDS may be suitable for evaluation of OS in advanced ESCC patients without LN metastasis.
背景
探讨阳性淋巴结对数比值（LODDS）对晚期食管鳞状细胞癌（ESCC）患者手术切除后预后的评估价值。
方法
回顾性分析260例行手术切除的晚期ESCC患者的临床资料。采用卡方检验和Cox回归模型进行单因素和多因素分析。绘制受试者工作特征（ROC）曲线，比较病理淋巴结（pN）和LODDS与3年或5年总生存期（OS）的相关性。进行切点分析，以确定是否存在与最大OS差异相关的LODDS临界值。
结果
平均随访时间为30个月（范围3至106个月）。1年、3年、5年OS率分别为70.0%、41.9%和30.3%。单因素分析显示，所有患者中，LODDS1、LODDS2、LODDS3和LODDS4组的5年OS率分别为51.2%、30.5%、24.6%和14.2%，中位生存时间分别为68.7、34.6、24.0和14.6个月（P = 0.000），亚组分析显示，155例无淋巴结转移（LN）的患者中该效应无变化（P = 0.024）。多因素分析显示，LODDS[风险比（HR）= 1.309，P = 0.003]是所有患者独立且显著的预后因素，在淋巴结阴性患者中LODDS（HR = 1.610，P = 0.038）也是如此。在预测3年OS时，LODDS分期的曲线下面积（AUC = 0.630）大于pN分期（AUC = 0.621），然而在预测5年OS时LODDS较小（分别为AUC = 0.620、0.631），差异无统计学意义（P均> 0.05）。最后，逐步分析确定LODDS的最佳切点为-1.2，这与淋巴结阴性患者的预后显著相关（P = 0.
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