Department of Esophageal Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Qinhuangdao, China.
Thorac Cancer. 2020 Dec;11(12):3490-3500. doi: 10.1111/1759-7714.13688. Epub 2020 Oct 9.
The aim of this study was to explore whether the ratio between negative and positive lymph nodes (R ) could predict the overall survival (OS) of esophageal cancer (EC) patients with lymph node metastasis following esophagectomy.
We utilized the Surveillance, Epidemiology and End Results (SEER) database to include the records of 2374 patients with lymph node metastases post-surgery. All patients were randomly assigned into the training cohort (n = 1424) and validation cohort (n = 950). Multivariate Cox regression analyses were performed to identify independent prognostic factors. A novel R -based TR M staging system was proposed. The prognostic value of N, R , TNM and TR M staging system was evaluated using the linear trend χ test, likelihood ratio χ test, and Akaike information criterion (AIC) to determine the potential superiorities. We constructed nomograms to predict survival in both cohorts, and the calibration curves confirmed the predictive ability.
Univariate analyses showed that N and R stage significantly influenced the OS of patients. Multivariate analyses revealed that R was an independent prognostic predictor in both the training and validation cohorts. For the stratification analysis in the two cohorts, we found significant differences in the prognosis of patients in different R groups on the basis of the different N stages and the number of dissected lymph nodes. In addition, the lower AIC value of R stage and TR M staging system represented superior predictive accuracy for OS than the N stage and TNM staging system, respectively. Furthermore, the calibration curves for the probability of three- and five-year survival showed good consistency between nomogram predictive abilities and actual observation.
We demonstrated that compared to the classical pathological lymph nodal staging system, the R stage showed superior predictive accuracy for OS and can serve as a more effective prognostic guidance for lymph node positive EC patients.
本研究旨在探讨阳性淋巴结与阴性淋巴结比值（R 值）能否预测接受食管癌根治术后伴有淋巴结转移的患者的总生存期（OS）。
我们利用监测、流行病学和最终结果（SEER）数据库，纳入了 2374 例术后伴有淋巴结转移的患者的记录。所有患者被随机分配到训练队列（n = 1424）和验证队列（n = 950）。采用多变量 Cox 回归分析来确定独立的预后因素。提出了一种基于 R 值的新的肿瘤浸润固有淋巴细胞（TRM）分期系统。采用线性趋势 χ2 检验、似然比 χ2 检验和 Akaike 信息准则（AIC）评估 N、R、TNM 和 TRM 分期系统的预后价值，以确定潜在的优势。我们构建了预测两个队列生存的列线图，校准曲线验证了其预测能力。
单因素分析显示，N 分期和 R 分期显著影响患者的 OS。多因素分析显示，R 分期是训练队列和验证队列中独立的预后预测因素。在两个队列的分层分析中，我们发现基于不同 N 分期和清扫淋巴结数量，不同 R 分组的患者预后存在显著差异。此外，R 分期和 TRM 分期系统的 AIC 值较低，分别代表了对 OS 预测的准确性优于 N 分期和 TNM 分期系统。此外，三、五年生存率的校准曲线显示，列线图预测能力与实际观察之间具有良好的一致性。
与经典的病理淋巴结分期系统相比，R 分期对 OS 的预测准确性更高，可为阳性淋巴结食管癌患者提供更有效的预后指导。
