Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan, P.R. China.
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China.
J Surg Res. 2019 Apr;236:2-11. doi: 10.1016/j.jss.2018.10.044. Epub 2018 Dec 4.
The aim of this study was to compare the prognostic impact of the lymph node ratio (LNR) versus positive lymph node count (PLNC) in patients who had undergone resection for distal cholangiocarcinoma.
We identified 448 patients with resected distal cholangiocarcinoma from the Surveillance, Epidemiology, and End Results database. The X-Tile program was used to calculate the cutoff values for the LNR and PLNC that discriminate survival. The overall survival and cancer-specific survival rates were calculated. Relationships between clinicopathological factors and patient survival were assessed using univariate and multivariate analyses.
The optimal cutoff values for the LNR and PLNC were 0.45 and 3, respectively. Univariate analysis revealed that tumor size, the American Joint Committee on Cancer stage, T stage, the LNR and PLNC were significantly associated with prognosis (P < 0.05). Multivariate analysis demonstrated that the LNR, T stage, and tumor size were independent prognostic factors for cancer-specific and overall survival, whereas PLNC was not. In the subgroup of patients with positive lymph nodes, patients with an LNR of greater than 0.45 had significantly worse cancer-specific survival (hazard ratio, 2.418; 95% confidence interval, 1.588 to 3.682; P < 0.001) and overall survival (hazard ratio, 2.149; 95% CI, 1.421 to 3.249; P < 0.001) than those with an LNR of 0.45 or less.
The LNR was a better predictor of long-term prognosis than PLNC in patients with distal cholangiocarcinoma.
本研究旨在比较淋巴结比率（LNR）与阳性淋巴结计数（PLNC）在接受远端胆管癌切除术患者中的预后影响。
我们从监测、流行病学和最终结果数据库中确定了 448 例接受远端胆管癌切除术的患者。使用 X-Tile 程序计算出区分生存的 LNR 和 PLNC 的截止值。计算总生存率和癌症特异性生存率。使用单因素和多因素分析评估临床病理因素与患者生存之间的关系。
LNR 和 PLNC 的最佳截止值分别为 0.45 和 3。单因素分析显示，肿瘤大小、美国癌症联合委员会分期、T 分期、LNR 和 PLNC 与预后显著相关（P<0.05）。多因素分析表明，LNR、T 分期和肿瘤大小是癌症特异性和总生存率的独立预后因素，而 PLNC 则不是。在阳性淋巴结患者亚组中，LNR 大于 0.45 的患者癌症特异性生存率（危险比，2.418；95%置信区间，1.588 至 3.682；P<0.001）和总生存率（危险比，2.149；95%置信区间，1.421 至 3.249；P<0.001）明显低于 LNR 为 0.45 或更低的患者。
LNR 是预测远端胆管癌患者长期预后的较好指标，优于 PLNC。
