Yang Yuesheng, Zheng Jiabin, Li Yong
Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China; Shantou University Medical College, Shantou, 515041, Guangdong Province, PR China.
Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China.
Eur J Surg Oncol. 2022 May;48(5):1017-1024. doi: 10.1016/j.ejso.2021.11.133. Epub 2021 Dec 1.
Directly applying the 8th American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) staging system to evaluate the prognosis of patients with esophagogastric junction adenocarcinoma (AEG) might lead to under-staging, when insufficient lymph nodes were retrieved during surgery. The prognostic value of 4 lymph nodes staging systems, 8th AJCC TNM N stage, lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), and negative lymph nodes (NLN), in AEG patients having ≤15 retrieved lymph nodes were compared.
869 AEG patients diagnosed between 2004 and 2012 with ≤15 retrieved lymph nodes were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were conducted to assess the association of cancer-specific survival (CSS) and overall survival (OS) with 8th AJCC TNM N stage, LNR, LODDS, and NLN respectively. Predictive survival ability was assessed and compared using linear trend χ2 score, likelihood ratio (LR) test, Akaike information criterion (AIC), Harrell concordance index (C-index), and Receiver Operative Curve (ROC).
The N stage, LNR, LODDS, and NLN were all independent prognostic predictors for CSS and OS in multivariate Cox models. Comparatively, LODDS demonstrated higher linear trend χ2 score, LR test score, C-index and integrated area under the curve (iAUC) value, and lower AIC in CSS compared to the other three systems. Moreover, for patients without regional lymph node metastasis, NLN showed higher C-index and lower AIC.
LODDS showed better predictive performance than N, LNR, and NLN among patients with node-positive patients while NLN performed better in node-negative patients. A combination of LODDS and NLN has the potential to provide more prognostic information than the current AJCC TNM classification.
当手术中获取的淋巴结数量不足时，直接应用美国癌症联合委员会（AJCC）第8版肿瘤淋巴结转移（TNM）分期系统评估食管胃交界腺癌（AEG）患者的预后可能会导致分期不足。比较了4种淋巴结分期系统（AJCC第8版TNM N分期、淋巴结比率（LNR）、阳性淋巴结对数优势（LODDS）和阴性淋巴结数（NLN））对获取淋巴结数≤15个的AEG患者的预后价值。
从监测、流行病学和最终结果（SEER）数据库中识别出2004年至2012年间诊断为AEG且获取淋巴结数≤15个的869例患者。进行单因素和多因素Cox回归分析，分别评估癌症特异性生存（CSS）和总生存（OS）与AJCC第8版TNM N分期、LNR、LODDS和NLN的相关性。使用线性趋势χ2评分、似然比（LR）检验、赤池信息准则（AIC）、哈雷尔一致性指数（C指数）和受试者工作特征曲线（ROC）评估并比较预测生存能力。
在多因素Cox模型中，N分期、LNR、LODDS和NLN均为CSS和OS的独立预后预测因素。相比之下，与其他三种系统相比，LODDS在CSS中显示出更高的线性趋势χ2评分、LR检验评分、C指数和曲线下综合面积（iAUC）值，以及更低的AIC。此外，对于无区域淋巴结转移的患者，NLN显示出更高的C指数和更低的AIC。
在淋巴结阳性患者中，LODDS的预测性能优于N、LNR和NLN，而NLN在淋巴结阴性患者中表现更好。LODDS和NLN联合使用有可能比当前的AJCC TNM分类提供更多的预后信息。
