Department of Rheumatology and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
EBioMedicine. 2019 Mar;41:276-285. doi: 10.1016/j.ebiom.2019.02.043. Epub 2019 Feb 26.
The prognostic roles of three common lymph node staging schemes, number of positive lymph nodes (pN), lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in small bowel adenocarcinoma (SBA) are unclear. We assessed their prognostic ability in SBA.
A total of 2128 patients diagnosed with SBA between 1988 and 2010 from the Surveillance, Epidemiology, and End Results (SEER) database and 186 patients from 15 hospitals in France and China were identified. We evaluated the prognostic ability of the schemes in both continuous and stratified patterns using R, Harrell's C, and time-dependent receiver operating characteristic curve analyses.
For continuous pattern, the LODDS had a better capacity of discrimination and higher accuracy of prognosis than pN and LNR. Similarly, the stratified LODDS classification had a better performance of discrimination and higher accuracy of prognosis than the pN and LNR classification. The multivariable model using the LODDS classification also showed superiorly predictive accuracy and discriminatory capacity to those of the 7th and, 8th TNM node and LNR classification. These results were fully validated in an independent international multicentre cohort.
The LODDS scheme showed a better prognostic performance than the LNR or pN schemes in patients with SBA regardless of continuous or stratified pattern. The LODDS scheme could serve as an auxiliary to lymph node staging systems in future revisions of the American Joint Committee on Cancer (AJCC) manual. FUND: This work was funded by the Zhejiang Province Natural Science Fund of China.
三种常见的淋巴结分期方案（阳性淋巴结数量（pN）、淋巴结比率（LNR）和对数阳性淋巴结优势比（LODDS））在小肠腺癌（SBA）中的预后作用尚不清楚。我们评估了它们在 SBA 中的预后能力。
从监测、流行病学和最终结果（SEER）数据库中确定了 1988 年至 2010 年间诊断为 SBA 的 2128 例患者和来自法国和中国的 15 家医院的 186 例患者。我们使用 R、Harrell 的 C 和时间依赖性接收者操作特征曲线分析评估了方案在连续和分层模式下的预后能力。
对于连续模式，LODDS 比 pN 和 LNR 具有更好的鉴别能力和更高的预后准确性。同样，分层 LODDS 分类在鉴别能力和预后准确性方面的表现优于 pN 和 LNR 分类。使用 LODDS 分类的多变量模型也显示出优于第 7 版和第 8 版 TNM 节点和 LNR 分类的预测准确性和鉴别能力。这些结果在一个独立的国际多中心队列中得到了充分验证。
LODDS 方案在 SBA 患者中显示出比 LNR 或 pN 方案更好的预后表现，无论连续模式还是分层模式。LODDS 方案可作为未来美国癌症联合委员会（AJCC）手册修订中淋巴结分期系统的辅助手段。
这项工作得到了中国浙江省自然科学基金的支持。
