Qu Jinglei, Qu Xiujuan, Li Zhi, Zhang Jingdong, Teng Yuee, Jin Bo, Zhao Mingfang, Yu Ping, Wang Zhenning, Liu Yunpeng
1 Department of Medical Oncology, Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China.
2 Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China.
Tumour Biol. 2017 Jun;39(6):1010428317698374. doi: 10.1177/1010428317698374.
It is currently unclear as to which patients with node-negative gastric cancer can benefit from adjuvant chemotherapy. This study aimed to develop a prognostic model based on patient-, tumor-, and host-related factors to stratify high-risk patients eligible for adjuvant therapy. Correlations of clinicopathological and hematological features with overall survival were analyzed using a Cox model. A score to identify risk classes was derived from hazard ratios in multivariate analysis. In all, 436 patients with node-negative gastric cancer (stage pT1-4aN0M0) were analyzed in this study. Multivariate analysis showed that age, depth of invasion, and neutrophil-lymphocyte ratio were independent prognostic indicators of overall survival, and a prognostic model was developed using these significant factors. Patients were stratified into three risk groups with significant differences in the 3-year survival rates (98.5%, 91.6%, and 70.7%, respectively; p < 0.001) according to their scores. The prognostic model improved the predictive accuracy of postoperative 3-year survival rate by 7% when compared with the pathological T stage. A model based on age, depth of invasion, and neutrophil-lymphocyte ratio is more effective than traditional staging systems in predicting the prognosis of node-negative gastric cancer. High-risk patients could be considered for adjuvant therapy.
目前尚不清楚哪些淋巴结阴性的胃癌患者能从辅助化疗中获益。本研究旨在基于患者、肿瘤和宿主相关因素建立一个预后模型，以对适合辅助治疗的高危患者进行分层。使用Cox模型分析临床病理和血液学特征与总生存期的相关性。通过多变量分析中的风险比得出一个用于识别风险类别的评分。本研究共分析了436例淋巴结阴性的胃癌患者（pT1-4aN0M0期）。多变量分析显示，年龄、浸润深度和中性粒细胞与淋巴细胞比值是总生存期的独立预后指标，并利用这些显著因素建立了一个预后模型。根据评分，患者被分为三个风险组，其3年生存率有显著差异（分别为98.5%、91.6%和70.7%；p<0.001）。与病理T分期相比，该预后模型将术后3年生存率的预测准确率提高了7%。基于年龄、浸润深度和中性粒细胞与淋巴细胞比值的模型在预测淋巴结阴性胃癌的预后方面比传统分期系统更有效。高危患者可考虑接受辅助治疗。
