Jin Shengming, Wang Junjie, Shen Yijun, Gan Hualei, Xu Peihang, Wei Yu, Wei Jiaming, Wu Junlong, Wang Beihe, Wang Jun, Yang Chen, Zhu Yao, Ye Dingwei
Department of Urology, Fudan University Shanghai Cancer Center, No.270 at Dong'an Road, Xuhui District, Shanghai, 200032, People's Republic of China.
Department of Oncology, Shanghai Medical College, Fudan University, No.130 at Dong'an Road, Xuhui District, Shanghai, 200032, People's Republic of China.
Int Urol Nephrol. 2020 Jan;52(1):87-95. doi: 10.1007/s11255-019-02294-z. Epub 2019 Sep 24.
In addition to standard TNM N staging, lymph node ratio (LNR) and log odds of metastatic lymph node (LODDS) staging methods have been developed for cancer staging. We compared the prognostic performance of the total number of lymph nodes examined (TNLE), number of metastatic lymph node (NMLN), LNR, and LODDS in prostate cancer.
Data from 1400 patients diagnosed with prostate cancer between 2004 and 2009 who underwent lymphadenectomy were extracted from the Surveillance Epidemiology and End Results database. Kaplan-Meier methods and multivariable Cox regression analysis were used to evaluate the prognostic value of different lymph node staging schemes in patients with lymph node metastasis.
Univariate analysis showed that age, T stage, radiotherapy history, Gleason score, LNR classification, LODDS classification, and NMLN except TNLE classification were significant prognostic factors for overall survival. In multivariate analysis, LNR classification, LODDS classification, and NMLN but TNLE classification remained significant prognostic factors for overall survival. LNR classification had the highest C-index (0.672; 95% confidence interval [CI]: 0.609-0.734) and the lowest Akaike information criterion (AIC) (4057.018), indicating the best prognostic performance. Scatter plots showed that LODDS increased with increasing LNR, exhibiting a strong overall correlation between these two lymph node staging methods (r = 0.9072). LNR and LODDS generally increased with increasing NMLN, although the correlation was relatively low.
Our results indicate that LNR and LODDS may be better predictors of overall survival than the AJCC/UICC N category in patients undergoing curative surgery for prostate cancer.
除了标准的TNM N分期外，还开发了淋巴结比率（LNR）和转移淋巴结对数优势（LODDS）分期方法用于癌症分期。我们比较了前列腺癌中检查的淋巴结总数（TNLE）、转移淋巴结数量（NMLN）、LNR和LODDS的预后性能。
从监测、流行病学和最终结果数据库中提取2004年至2009年间1400例接受前列腺癌诊断并接受淋巴结清扫术患者的数据。采用Kaplan-Meier方法和多变量Cox回归分析来评估不同淋巴结分期方案对有淋巴结转移患者的预后价值。
单变量分析显示，年龄、T分期、放疗史、Gleason评分、LNR分类、LODDS分类以及除TNLE分类外的NMLN是总生存的显著预后因素。在多变量分析中，LNR分类、LODDS分类和NMLN而非TNLE分类仍然是总生存的显著预后因素。LNR分类具有最高的C指数（0.672；95%置信区间[CI]：0.609 - 0.734）和最低的赤池信息准则（AIC）（4057.018），表明其预后性能最佳。散点图显示，LODDS随LNR增加而增加，表明这两种淋巴结分期方法之间存在很强的总体相关性（r = 0.9072）。LNR和LODDS通常随NMLN增加而增加，尽管相关性相对较低。
我们的结果表明，对于接受前列腺癌根治性手术的患者，LNR和LODDS可能比AJCC/UICC N分类更能预测总生存。
