Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30 Gaotanyan Road, Chongqing, 400038, China.
Department of Clinical Center of Oncology, Zhejiang University Lishui Hospital, Lishui, 323000, Zhejiang, China.
J Gastrointest Surg. 2022 May;26(5):1030-1040. doi: 10.1007/s11605-021-05211-x. Epub 2022 Jan 1.
An important prognostic indicator of hilar cholangiocarcinoma (HCCA) in patients after surgery is metastasis of lymph nodes (LN). However, there are many types of LN staging systems to the issue of a better determination of the prognosis of patients through the lymphatic staging system which needs research. Based on the above, we tried to re-evaluate the staging system of HCCA LNs. We compared the American Joint Committee on Cancer (AJCC), number of metastatic LNs (MLN), ratio of LN (LNR), and log odds of MLNs (LODDS) in individuals undergoing curative resection to determine the best LN staging system.
In the current study, we retrospectively analyzed 229 patients undergoing curative resection. We evaluated the impact of the stage of AJCC pN, LNR, LODDS, and MLN on OS (overall survival) and RFS (recurrence-free survival). According to the curve of receiver operating characteristic (ROC), we compared the predictive capacity of different staging systems of LN for survival and recurrence.
Multivariate analysis results revealed that LODDS > - 0.45 (95% CI = 1.115-2.709, P = 0.015; 95% CI = 1.187-2.780, P = 0.006) are independent risk factors affecting OS and RFS, respectively. Compared with LN status, AJCC pN stage, MLN, and LNR, the variable having the highest area under the ROC curve (AUC) was LODDS when predicting 1-year, 3-year, and 5-year OS and RFS.
This study shows that metastasis of LNs is a key indicator for predicting patient death and recurrence. Among them, LODDS is the best LN staging system for the prognostic evaluation of HCCA patients after surgery. Clinicians can incorporate LODDS into HCCA patient lymphatic staging system for a more accurate prognosis of HCCA patients post-surgery.
在接受手术的肝门部胆管癌（HCCA）患者中，淋巴结转移（LN）是一个重要的预后指标。然而，存在许多类型的 LN 分期系统，需要通过淋巴分期系统更好地确定患者的预后。基于上述情况，我们试图重新评估 HCCA LN 的分期系统。我们比较了美国癌症联合委员会（AJCC）、转移的 LN 数量（MLN）、LN 比率（LNR）和对数优势比的 MLN（LODDS）在接受根治性切除的个体中的表现，以确定最佳的 LN 分期系统。
在本研究中，我们回顾性分析了 229 例接受根治性切除的患者。我们评估了 AJCC pN 分期、LNR、LODDS 和 MLN 分期对 OS（总生存）和 RFS（无复发生存）的影响。根据接收者操作特征（ROC）曲线，我们比较了不同 LN 分期系统对生存和复发的预测能力。
多变量分析结果显示，LODDS > -0.45（95%CI = 1.115-2.709，P = 0.015；95%CI = 1.187-2.780，P = 0.006）是影响 OS 和 RFS 的独立危险因素。与 LN 状态、AJCC pN 分期、MLN 和 LNR 相比，在预测 1 年、3 年和 5 年 OS 和 RFS 时，ROC 曲线下面积（AUC）最高的变量是 LODDS。
本研究表明，LN 转移是预测患者死亡和复发的关键指标。其中，LODDS 是预测 HCCA 患者术后生存和复发的最佳 LN 分期系统。临床医生可以将 LODDS 纳入 HCCA 患者的淋巴分期系统，以更准确地预测 HCCA 患者术后的预后。
