Xu Tianlei, Zhang Lin, Yu Liang, Zhu Yuelu, Fang Hui, Chen Bo, Zhang Haizeng
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2021 Apr;9(8):637. doi: 10.21037/atm-20-7590.
Neoadjuvant chemoradiotherapy (NCRT) results in fewer lymph nodes harvested and causes staging migration. Therefore, we compared the prognostic value of the logarithmic odds of positive lymph nodes (LODDS) with the lymph node ratio (LNR) and the American Joint Committee on Cancer (AJCC) ypN stage in patients with locally advanced rectal cancer (LARC) after NCRT.
A total of 445 patients with LARC who received NCRT and underwent radical surgery between January 2004 and December 2015 were recruited, and data from 4881 patients included in the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2013 were analyzed to verify our results. The time-dependent area under the receiver operating characteristic curve (TimeROC) was used to evaluate the discriminative ability of the different lymph node staging systems.
ypN staging failed to satisfactorily stratify the patients treated with NCRT [the 3-year disease-free survival (DFS) rates were 65.7% and 55.4% for the ypN1 and ypN2 groups, respectively, P=0.252]. The LODDS classification was significantly associated with DFS, and the 3-year DFS rates for the LODDS0, LODDS1, and LODDS2 groups were 89.9%, 72.4%, and 53.9%, respectively (P<0.05 across all groups). Furthermore, the LODDS classification system was able to subclassify patients with ypN0 stage tumors regardless of whether ≥12 or <12 total lymph nodes (TLNs) were harvested. TimeROC analysis showed that the LODDS classification (AUC, median: 0.722, range: 0.692-0.754) had a higher accuracy for determining the prognosis than the ypN stage (AUC, median: 0.691, range: 0.684-0.712) or the LNR (AUC, median: 0.703, range: 0.685-0.730) classification, regardless of lymph node status. These results were verified using the SEER database.
The LODDS was a better prognostic factor for DFS than ypN staging or the LNR-based approach in patients with LARC after NCRT, particularly those with <12 TLNs harvested or ypN0 stage disease.
新辅助放化疗（NCRT）导致切除的淋巴结数量减少并引起分期迁移。因此，我们比较了局部晚期直肠癌（LARC）患者在接受NCRT后，阳性淋巴结对数比值（LODDS）与淋巴结比率（LNR）以及美国癌症联合委员会（AJCC）ypN分期的预后价值。
共纳入2004年1月至2015年12月期间接受NCRT并接受根治性手术的445例LARC患者，并分析了2010年至2013年监测、流行病学和最终结果（SEER）数据库中4881例患者的数据以验证我们的结果。采用时间依赖性受试者工作特征曲线下面积（TimeROC）评估不同淋巴结分期系统的判别能力。
ypN分期未能令人满意地对接受NCRT治疗的患者进行分层[ypN1组和ypN2组的3年无病生存率（DFS）分别为65.7%和55.4%，P = 0.252]。LODDS分类与DFS显著相关，LODDS0、LODDS1和LODDS2组的3年DFS率分别为89.9%、72.4%和53.9%（所有组间P<0.05）。此外，无论总共切除的淋巴结（TLN）数量是≥12个还是<12个，LODDS分类系统都能够对ypN0期肿瘤患者进行亚分类。TimeROC分析表明，无论淋巴结状态如何，LODDS分类（AUC，中位数：0.722，范围：0.692 - 0.754）在确定预后方面比ypN分期（AUC，中位数：0.691，范围：0.684 - 0.712）或LNR分类（AUC，中位数：0.703，范围：0.685 - 0.730）具有更高的准确性。这些结果在SEER数据库中得到了验证。
在接受NCRT后的LARC患者中，对于DFS而言，LODDS是比ypN分期或基于LNR的方法更好的预后因素，尤其是对于那些切除的TLN数量<12个或患有ypN0期疾病的患者。
