College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China.
Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, 150040, China.
Int J Surg. 2018 Sep;57:76-83. doi: 10.1016/j.ijsu.2018.08.002. Epub 2018 Aug 10.
The lymph node ratio (LNR) as a prognostic parameter for gastric cancer has yet to be fully validated in the current tumor node metastasis staging system. We assessed the prognostic role of LNR in lymph node-positive gastric cancer through a meta-analysis.
PubMed and EMBASE were searched for relevant studies up until December 2016. The effect measure for meta-analysis of primary outcomes was the hazard ratio (HR) for overall survival. Pooled HRs and 95% confidence intervals were calculated using random effects models. The I statistic was used to measure heterogeneity. Subgroup analysis and meta-regression were chosen to illustrate the potential heterogeneity of the risk factors of outcomes. Publication bias was assessed using Egger's test and Begg's funnel plots. Sensitivity analysis was applied to evaluate the origin of the heterogeneity.
We included 27 studies in this meta-analysis. Higher LNRs were significantly associated with a shorter overall survival (OS). High heterogeneity among the studies was identified (I = 85.6), and the publication bias was moderate. Subgroup analysis showed similar results, and elevated LNR was associated with late-stage gastric cancer and indicative of a worse prognosis. Univariate meta-regression analysis of OS indicated that both treatment type and ethnicity may be causes of heterogeneity in patients with gastric cancer (p values were 0.005 and 0.008, respectively).
LNR was associated with a significantly poorer OS and LNR was an independent predictor of survival in patients with gastric cancer. LNR should be added as one of the parameters to be used in future tumor staging classification systems.
在目前的肿瘤淋巴结转移分期系统中，淋巴结比率（LNR）作为胃癌预后参数尚未得到充分验证。我们通过荟萃分析评估了 LNR 在淋巴结阳性胃癌中的预后作用。
检索了 PubMed 和 EMBASE 数据库，以获取截至 2016 年 12 月的相关研究。主要结局的荟萃分析效应量为总生存的风险比（HR）。使用随机效应模型计算合并的 HR 和 95%置信区间。使用 I 统计量来衡量异质性。选择亚组分析和荟萃回归来说明结局风险因素的潜在异质性。使用 Egger 检验和 Begg 漏斗图评估发表偏倚。进行敏感性分析以评估异质性的来源。
我们纳入了这项荟萃分析中的 27 项研究。较高的 LNR 与较短的总生存期（OS）显著相关。研究之间存在高度异质性（I=85.6），且发表偏倚为中度。亚组分析显示了相似的结果，较高的 LNR 与晚期胃癌相关，提示预后较差。OS 的单变量荟萃回归分析表明，治疗类型和种族可能是胃癌患者异质性的原因（p 值分别为 0.005 和 0.008）。
LNR 与明显较差的 OS 相关，并且是胃癌患者生存的独立预测因子。LNR 应作为未来肿瘤分期分类系统中使用的参数之一。
