Chen Hui-Min, Feng Ge
Nanjing Jiangbei People's Hospital, Nanjing 220000, People's Republic of China,
Onco Targets Ther. 2019 Jan 8;12:449-455. doi: 10.2147/OTT.S186642. eCollection 2019.
The number of lymph nodes (LNs) excised in patients with pathologic N0 is limited, and it is very likely that there will be recessive node disease after surgery, so they are at risk of understaging. The purpose of the present study is to develop a nodal staging score (NSS) in a mathematical way to assess the likelihood that a pathologic N0 gastric cancer (GCa) patient has, indeed, no occult nodal disease after surgery.
A total of 14,033 stage I-III GCa patients were identified from Surveillance, Epidemiology and End Results database for analysis. A beta-binomial model was fitted to calculate the probability of missing a nodal disease. This probability is then used to calculate the NSS.
The probability of missing a nodal disease is decreased with increasing LNs examined across all pT stages. Seven and 24 LNs removed and examined was enough for an NSS of 90% in pT1 and pT2 patients, respectively, ensuring a high confidence of correct nodal negative classification. Twenty-three and 31 LNs examined in pT3 and pT4 patients could also maintain the NSS at 80%, respectively. NSS had a significant impact on patients' survival across all pT stages (all s <0.0001).
The probability that GCa patients are free of true nodal disease could be provided by NSS-based prediction, which is conducive to postoperative decision and survival surveillance. In addition, NSS can define a subtle standard on how many LNs examined are enough for adequate staging dependent on pT stages. However, at least 16 LNs examined is the standard recommendation to date.
病理分期为N0的患者切除的淋巴结数量有限，术后很可能存在隐匿性淋巴结疾病，因此有分期不足的风险。本研究的目的是以数学方式制定一种淋巴结分期评分（NSS），以评估病理分期为N0的胃癌（GCa）患者术后确实不存在隐匿性淋巴结疾病的可能性。
从监测、流行病学和最终结果数据库中识别出总共14033例I - III期GCa患者进行分析。采用β - 二项式模型计算遗漏淋巴结疾病的概率。然后用这个概率来计算NSS。
在所有pT分期中，随着检查的淋巴结数量增加，遗漏淋巴结疾病的概率降低。对于pT1和pT2患者，分别切除并检查7个和24个淋巴结足以使NSS达到90%，确保正确的淋巴结阴性分类具有较高的可信度。pT3和pT4患者分别检查23个和31个淋巴结也可使NSS维持在80%。在所有pT分期中，NSS对患者的生存有显著影响（所有P<0.0001）。
基于NSS的预测可以提供GCa患者不存在真正淋巴结疾病的概率，这有助于术后决策和生存监测。此外，NSS可以根据pT分期确定一个关于检查多少个淋巴结足以进行充分分期的精细标准。然而，迄今为止标准建议是至少检查16个淋巴结。
