Agnes Annamaria, Biondi Alberto, Cananzi Ferdinando M, Rausei Stefano, Reddavid Rossella, Laterza Vito, Galli Federica, Quagliuolo Vittorio, Degiuli Maurizio, D'Ugo Domenico, Persiani Roberto
Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
J Surg Oncol. 2019 Jun;119(7):948-957. doi: 10.1002/jso.25411. Epub 2019 Feb 11.
The current and the previous editions of the tumor-node-metastasis (TNM) system for gastric cancer (GC; TNM8 and TNM7) have a high risk of stage-migration bias when the node count after gastrectomy is suboptimal. Hence, they are possibly not the optimal staging systems for GC patients. This study aims to compare the TNM with two systems less affected by the stage-migration bias, namely, the lymph nodes ratio (LNR) and the log odds of positive lymph nodes (LODDS), to assess which one is the best in stratifying the prognosis of GC patients.
The sample study included 1221 GC patients. Two 7-cluster staging systems based on the combination of pT categories and LNR and LODDS categories (TLNR and TLODDS) were compared with the two last editions of TNM, using the Akaike information criteria, the Bayesian information criteria, and the receiver operating characteristic (ROC) curve graphs. Further validation on an independent sample of 251 patients was carried out.
The univariable and multivariable analyses and the ROC curves detected an advantage of the TLNR and TLODDS systems over the TNM. The TLNR and TLODDS showed the best accuracy both in the subgroup of patients with ≥16 nodes examined. The results were confirmed in the validation analysis.
TLNR and TLODDS staging systems should be considered a valid implementation of the TNM for the prognostic stratification of GC patients. If these results are confirmed in further studies, the future implementation of the TNM should consider the introduction of the LNR or the LODDS along with the number of metastatic nodes.
对于胃癌（GC）患者，当胃切除术后的淋巴结计数不理想时，当前和上一版的肿瘤-淋巴结-转移（TNM）系统（TNM8和TNM7）存在较高的分期迁移偏倚风险。因此，它们可能并非GC患者的最佳分期系统。本研究旨在将TNM与另外两个受分期迁移偏倚影响较小的系统，即淋巴结比率（LNR）和阳性淋巴结对数比值（LODDS）进行比较，以评估哪一个在分层GC患者预后方面最佳。
样本研究纳入了1221例GC患者。基于pT类别与LNR和LODDS类别的组合构建的两个7组分期系统（TLNR和TLODDS），与TNM的最后两版进行比较，采用赤池信息准则、贝叶斯信息准则和受试者操作特征（ROC）曲线图。对251例患者的独立样本进行了进一步验证。
单变量和多变量分析以及ROC曲线显示TLNR和TLODDS系统优于TNM。在检查淋巴结≥16个的患者亚组中，TLNR和TLODDS显示出最佳准确性。验证分析证实了这些结果。
TLNR和TLODDS分期系统应被视为TNM在GC患者预后分层方面的有效实施方案。如果这些结果在进一步研究中得到证实，TNM的未来实施方案应考虑引入LNR或LODDS以及转移淋巴结数量。
