Department of Surgery, Cabrini Hospital, Cabrini Monash University, Malvern, VIC, 3144, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
BMC Cancer. 2020 Aug 14;20(1):762. doi: 10.1186/s12885-020-07260-y.
BACKGROUND: Globally, colorectal cancer (CRC) is the third and second leading cancer in men and women respectively with 600,000 deaths per year. Traditionally, clinicians have relied solely on nodal disease involvement, and measurements such as lymph node ratio (LNR; the ratio of metastatic/positive lymph nodes to total number of lymph nodes examined), when determining patient prognosis in CRC. The log odds of positive lymph nodes (LODDS) is a logistic transformation formula that uses pathologic lymph node data to stratify survival differences among patients within a single stage of disease. This formula allows clinicians to identify whether patients with clinically aggressive tumours fall into higher-risk groups regardless of nodal positivity and can potentially guide adjuvant treatment modalities. The aim of this study was to investigate whether LODDS in colon cancer provides better prognostication compared to LNR. METHODS: A retrospective study of patients on the prospectively maintained Cabrini Monash University Department of Surgery colorectal neoplasia database, incorporating data from hospitals in Melbourne Australia, identified patients entered between January 2010 and March 2016. Association of LODDS and LNR with clinical variables were analysed. Disease-free (DFS) and overall (OS) survival were investigated with Cox regression and Kaplan-Meier survival analyses. RESULTS: There were 862 treatment episodes identified in the database (402 male, 47%). The median patient age was 73 (range 22-100 years). There were 799 colonic cancers and 63 rectosigmoid cancers. The lymph node yield (LNY) was suboptimal (< 12) in 168 patients (19.5%) (p = 0.05). The 5-year OS for the different LNR groups were 86, 91 and 61% (p < 0.001) for LNR (655 episodes), LNR (128 episodes) and LNR (78 episodes), respectively. For LODDS, they were 85, 91 and 61% (p < 0.001) in LODDS (569 episodes), LODDS (217 episodes) and LODDS (75 episodes) groups (p < 0.001). Overall survival rates were comparable between the LNR and LODDS group and for LNY < 12 and stage III patients when each were sub-grouped by LODDS and LNR. CONCLUSION: This study has shown for that the prognostic impact of LODDS is comparable to LNR for colon cancer patients. Accordingly, LNR is recommended for prognostication given its ease of calculation.
背景：在全球范围内，结直肠癌（CRC）分别是男性和女性中第三和第二大常见癌症，每年导致 60 万人死亡。传统上，临床医生仅依靠淋巴结疾病的受累情况以及淋巴结比率（LNR；转移/阳性淋巴结与检查的淋巴结总数的比率）等指标来确定 CRC 患者的预后。阳性淋巴结的对数优势（LODDS）是一种逻辑转换公式，它使用病理淋巴结数据来对疾病同一分期内的患者的生存差异进行分层。该公式使临床医生能够识别出是否存在具有临床侵袭性肿瘤的患者属于更高风险组，而与淋巴结阳性无关，并且可以潜在地指导辅助治疗方式。本研究的目的是调查 LODDS 在结肠癌中的预后是否优于 LNR。
方法：对前瞻性维护的卡布里尼莫纳什大学外科结直肠肿瘤数据库中的患者进行回顾性研究，该数据库纳入了澳大利亚墨尔本医院的数据，入组时间为 2010 年 1 月至 2016 年 3 月。分析 LODDS 和 LNR 与临床变量的关联。采用 Cox 回归和 Kaplan-Meier 生存分析研究无病（DFS）和总（OS）生存情况。
结果：数据库中确定了 862 例治疗病例（男性 402 例，女性 47%）。中位患者年龄为 73 岁（22-100 岁）。有 799 例结肠癌症和 63 例直肠乙状结肠癌。168 例患者（19.5%）的淋巴结产量（LNY）不足（<12）（p=0.05）。不同 LNR 组的 5 年 OS 分别为 LNR（569 例）的 86%、91%和 61%（p<0.001），LNR（128 例）的 91%和 61%（p<0.001），LNR（78 例）的 61%（p<0.001）。对于 LODDS，在 LODDS（569 例）、LODDS（217 例）和 LODDS（75 例）组中，分别为 85%、91%和 61%（p<0.001）。当将 LNY<12 和 III 期患者分别根据 LODDS 和 LNR 进行亚组分析时，LODDS 组和 LNR 组的总体生存率相似。
结论：本研究表明，LODDS 对结肠癌患者的预后影响与 LNR 相当。因此，鉴于 LNR 易于计算，建议将其用于预后。
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