Lai Hongkun, Zheng Jiabin, Li Yong
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Surg. 2022 May 27;9:918198. doi: 10.3389/fsurg.2022.918198. eCollection 2022.
Neoadjuvant treatment leads in a reduction in positive lymph nodes and examined lymph nodes (ELN), which may affect assessment of lymph node staging and postoperative treatment. We aimed to compare the staging systems of lymph node ratio (LNR), the positive logarithm ratio of lymph nodes (LODDS), negative lymph nodes (NLN), and the 8th AJCC ypN stage for patients with gastric adenocarcinoma after neoadjuvant therapy.
Data was collected from the Surveillance, Epidemiology, and End Results database and 1,551 patients with gastric adenocarcinoma who underwent neoadjuvant therapy and radical surgery were enrolled. Harrell's concordance index, the Receiver Operative Curve, the likelihood ratio test, and the Akaike information criterion were used to compare the predictive abilities of the different staging systems.
Among the 1,551 patients, 689 (44.4%) had ELN < 16 and node-negative patients accounted for 395 (25.5%). When regarded as the categorical variable, LNR had better discrimination power, higher homogeneity, and better model fitness for CSS and OS compared to other stage systems, regardless of the status of ELN. When regarded as the continuos variable, LODDS outperformed others for CSS. Furthermore, the NLN staging system performed superior to others in node-negative patients.
LNR had a better predictive performance than ypN, LODDS and NLN staging systems regardless of the status of ELN when regarded as the categorical variable, whereas LOODS became the better predictive factor for CSS when regarded as the continuos variable. In node-negative patients, NLN might be a feasible option for evaluating prognosis. A combination of LNR and NLN should be considered as user-friendly method in the clinical prognostic assessment.
新辅助治疗可减少阳性淋巴结和送检淋巴结数量，这可能会影响淋巴结分期评估和术后治疗。我们旨在比较新辅助治疗后胃腺癌患者的淋巴结比率（LNR）、淋巴结阳性对数比率（LODDS）、阴性淋巴结（NLN）分期系统以及第8版美国癌症联合委员会（AJCC）ypN分期。
数据来自监测、流行病学和最终结果数据库，纳入1551例行新辅助治疗及根治性手术的胃腺癌患者。采用Harrell一致性指数、受试者工作特征曲线、似然比检验和赤池信息准则比较不同分期系统的预测能力。
1551例患者中，689例（44.4%）送检淋巴结数量＜16枚，395例（25.5%）为淋巴结阴性患者。无论送检淋巴结状态如何，当LNR作为分类变量时，与其他分期系统相比，其对癌症特异性生存（CSS）和总生存（OS）具有更好的区分能力、更高的同质性和更好的模型拟合度。当作为连续变量时，LODDS在CSS方面优于其他指标。此外，在淋巴结阴性患者中，NLN分期系统表现优于其他系统。
当LNR作为分类变量时，无论送检淋巴结状态如何，其预测性能均优于ypN、LODDS和NLN分期系统；而当作为连续变量时，LODDS成为CSS的更好预测因素。在淋巴结阴性患者中，NLN可能是评估预后的可行选择。在临床预后评估中，应考虑将LNR和NLN联合作为一种实用的方法。
