Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Cancer Med. 2021 Dec;10(23):8542-8557. doi: 10.1002/cam4.4366. Epub 2021 Nov 18.
PURPOSE: To evaluate the impact of the log odds of positive lymph nodes (LODDS) on cancer-specific survival (CSS) in colon mucinous adenocarcinoma (MAC) patients, compared with pN stage and the lymph nodes ratio (LNR). METHODS: A total of 10,182 colon MAC patients from the Surveillance, Epidemiology, and End Results database were divided into the training group. The external validation group included 153 patients from Fujian Medical University Union Hospital. The Cox regression method was used to identify prognostic risk factors. Nomograms were evaluated by Harrell's concordance index (C-index) and calibration curves. Recursive partitioning analysis (RPA) was used to develop a novel staging system. RESULTS: Time-dependent receiver operating characteristic curves (ROC) to predict CSS showed the areas under the ROC curve of LODDS were always higher than pN stage and LNR. LNR and LODDS classifications can well distinguish the prognosis of patients with the same pN stage. Cox analyses indicated that age, tumor size, pT stage, pN stage, LNR, and LODDS were independent predictors of CSS (p < 0.05). Based on three lymph nodes classifications, we constructed three prognostic nomograms models for CSS. The C-index of the pN, LNR, and LODDS classification nomograms were 0.746 (95% confidence interval [95% CI]: 0.736-0.756), 0.750 (95% CI: 0.740-0.760), and 0.758 (95% CI: 0.748-0.768), respectively. In external validation, we observed the C-index of LODDS classification nomograms was 0.787 (95% CI: 0.648-0.926). RPA stage, including four stages, was constructed successfully based on pT stage and LNR or LODDS, respectively. The 3-, 5-, and 8-year areas under the ROC curve of LNR-RPA stage and LODDS-RPA stage were superior to tumor-node-metastasis stage. CONCLUSION: LODDS to be a better prognostic factor of CSS for colon MAC patients than pN stage and LNR. A nomogram and RPA stage base on LODDS can provide accurate information for personalized cancer treatment.
目的:评估对数阳性淋巴结(LODDS)对结直肠黏液腺癌(MAC)患者癌症特异性生存(CSS)的影响,与 pN 分期和淋巴结比率(LNR)相比。
方法:从监测、流行病学和最终结果(SEER)数据库中选取 10182 例结直肠 MAC 患者作为训练组。外部验证组包括来自福建医科大学附属协和医院的 153 例患者。使用 Cox 回归方法识别预后危险因素。通过 Harrell 一致性指数(C 指数)和校准曲线评估列线图。递归分区分析(RPA)用于开发新的分期系统。
结果:时间依赖性接受者操作特征曲线(ROC)预测 CSS 的结果显示,LODDS 的 ROC 曲线下面积始终高于 pN 分期和 LNR。LNR 和 LODDS 分类可以很好地区分具有相同 pN 分期的患者的预后。Cox 分析表明,年龄、肿瘤大小、pT 分期、pN 分期、LNR 和 LODDS 是 CSS 的独立预测因素(p<0.05)。基于三个淋巴结分类,我们构建了三个用于 CSS 的预后列线图模型。pN、LNR 和 LODDS 分类列线图的 C 指数分别为 0.746(95%置信区间[95%CI]:0.736-0.756)、0.750(95%CI:0.740-0.760)和 0.758(95%CI:0.748-0.768)。在外部验证中,我们观察到 LODDS 分类列线图的 C 指数为 0.787(95%CI:0.648-0.926)。基于 pT 分期和 LNR 或 LODDS,成功构建了包括四个阶段的 RPA 分期。LNR-RPA 分期和 LODDS-RPA 分期的 3、5 和 8 年 ROC 曲线下面积均优于肿瘤-淋巴结-转移(TNM)分期。
结论:LODDS 是结直肠 MAC 患者 CSS 的比 pN 分期和 LNR 更好的预后因素。基于 LODDS 的列线图和 RPA 分期可为个性化癌症治疗提供准确信息。
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