Cancer Center of Linyi People's Hospital, Shandong University, School of Medicine, Linyi, 276000, Shandong Province, P. R. China.
Department of Central Laboratory, Linyi People's hospital, Shandong University, School of medicine, Linyi, 276000, Shandong Province, P. R. China.
BMC Cancer. 2020 Dec 7;20(1):1200. doi: 10.1186/s12885-020-07664-w.
The study aimed to propose a modified N stage of esophageal cancer (EC) on the basis of the number of positive lymph node (PLN) and the number of negative lymph node (NLN) simultaneously.
Data from 13,491 patients with EC registered in the SEER database were reviewed. The parameters related to prognosis were investigated using a Cox proportional hazards regression model. A modified N stage was proposed based on the cut-off number of the re-adjusted ratio of the number of PLN (PLN) to the number of NLN (NLN), which were derived from the comparison of the hazard rate (HR) of PLN and NLN. The modified N stage was confirmed using the cross-validation method with the training and validation cohort, and it was also compared to the N stage from the American Joint Committee on Cancer (AJCC) staging system (7th edition) using Receiver Operating Characteristic (ROC) curve analysis.
The PLN on prognosis was 1.042, while NLN was 0.968. The modified N stage was defined as follows: N1 stage: the ratio range was from 0 to 0.21; N2 stage: more than 0.21, but no more than 0.48; N3 stage: more than 0.48. The log-rank test indicated that significant survival differences were confirmed among the N1, N2 and N3 sub-groups of patients in the training population. The difference of all the patients using the modified N stage method were more significant than AJCC N stage. The result of ROC analysis indicated that the modified N stage could represent the N stage of EC more accurately.
The modified N stage based on the re-adjusted ratio of PLN to NLN can evaluate tumor stage more accurately than the traditional N stage.
本研究旨在基于阳性淋巴结（PLN）和阴性淋巴结（NLN）的数量，提出食管癌（EC）改良 N 分期。
回顾了来自 SEER 数据库的 13491 例 EC 患者的数据。使用 Cox 比例风险回归模型研究与预后相关的参数。根据 PLN 与 NLN 数量的重新调整比值（PLN/NLN）的截止值，提出了改良 N 分期，该截止值是通过比较 PLN 和 NLN 的风险比（HR）得出的。使用训练和验证队列的交叉验证方法验证了改良 N 分期，并使用受试者工作特征（ROC）曲线分析将其与美国癌症联合委员会（AJCC）分期系统（第 7 版）的 N 分期进行比较。
PLN 对预后的影响为 1.042，NLN 为 0.968。改良 N 分期定义为：N1 期：比值范围为 0 至 0.21；N2 期：大于 0.21，但不超过 0.48；N3 期：大于 0.48。对数秩检验表明，在训练人群中，N1、N2 和 N3 亚组患者的生存差异具有统计学意义。使用改良 N 分期方法的所有患者的差异均比 AJCC N 分期更为显著。ROC 分析结果表明，改良 N 分期能更准确地反映 EC 的 N 分期。
基于 PLN 与 NLN 重新调整比值的改良 N 分期比传统 N 分期能更准确地评估肿瘤分期。
