Zhang Wenjie, Zhangyuan Guangyan, Wang Jincheng, Jin Kangpeng, Liu Yang, Wang Fei, Yu Weiwei, Zhang Haitian, Li Guoqiang, Yu Decai, Chen Huihui, Xu Qingxiang, Sun Beicheng
Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210029, Jiangsu Province, P.R. China.
Department of Hepatobiliary Surgery of Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, China.
J Cancer. 2019 Sep 7;10(23):5646-5653. doi: 10.7150/jca.30979. eCollection 2019.
: The retrieved lymph node (LN) count has been confirmed as a prognostic indicator in various cancers. However, the correlation between LN counts and patient prognosis in gastric cancer with node-positive is not fully studied. : A total of 8475 patients undergoing gastrectomy in Surveillance, Epidemiology, and End Results Program (SEER)-registered gastric cancer were analyzed. Kaplan-Meier methods and multivariable Cox regression models were used to analyze long-term outcomes and risk factors. Moreover, nomograms including LN counts were established to predict overall survival (OS) and cancer-specific survival (CSS), and Harrell's concordance index (c-index) was adopted to evaluate prediction accuracy. : Patients were stratified into 1-6, 7-14, and > 14 subgroups according to the optimal cutoff for retrieved LNs in terms of 5-year CSS. Further analysis indicated that higher LN counts were an independent predictor of longer survival in each N category. Nomograms on CSS and OS were established according to all significant factors, and c-indexes were 0.663 and 0.654 (P< 0.001), respectively. : These results indicated that the more the LNs retrieved, the better the survival would be. Nomograms incorporating LN counts can be recommended as practical models to provide more accurate prognostic information for GC patients.
已证实获取的淋巴结(LN)数量是多种癌症的预后指标。然而,LN数量与淋巴结阳性胃癌患者预后之间的相关性尚未得到充分研究。
对监测、流行病学和最终结果计划(SEER)注册的胃癌中8475例行胃切除术的患者进行了分析。采用Kaplan-Meier方法和多变量Cox回归模型分析长期结局和危险因素。此外,建立了包括LN数量的列线图以预测总生存期(OS)和癌症特异性生存期(CSS),并采用Harrell一致性指数(c指数)评估预测准确性。
根据5年CSS中获取的LN的最佳临界值,将患者分为1 - 6、7 - 14和>14亚组。进一步分析表明,在每个N类别中,较高的LN数量是更长生存期的独立预测因素。根据所有显著因素建立了CSS和OS的列线图,c指数分别为0.663和0.654(P<0.001)。
这些结果表明,获取的LN越多,生存期越好。包含LN数量的列线图可作为实用模型推荐,为GC患者提供更准确的预后信息。