Yang Yan, Wang Yawei, Wang Zhengbin
Department of General Surgery, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China.
Department of Gastrointestinal Surgery, Clinical Medical School, Northern Jiangsu People's Hospital affiliated to Yangzhou University, Yangzhou, China.
Front Surg. 2022 Aug 25;9:929576. doi: 10.3389/fsurg.2022.929576. eCollection 2022.
This study aims to construct a new staging system for colorectal cancer (CRC) based on the lymph node ratio (LNR) as a supplement to the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system for predicting the prognosis of CRC patients with <12 lymph nodes.
The data of 26,695 CRC patients with <12 lymph nodes were extracted from the Surveillance, Epidemiology, and End Results (SEER) database as a training set. A total of 635 CRC patients were also enrolled from Northern Jiangsu People's Hospital affiliated with Yangzhou University as an independent validation set. Classification and regression tree analysis was used to obtain the LNR cutoff value. Survival curves were estimated using the Kaplan-Meier method, and the log-rank test was used for comparisons of differences among the survival curves. The monotonic decreasing trend of the overall survival curve in the staging system was expressed by the linear correlation degree R.
The 5-year survival rates of patients in the training set based on the AJCC staging system from stage I to stage IV were 75.6% (95%CI: 74.4-76.8), 59.8% (95%CI: 58.6-61.0), 42.1% (95%CI: 34.5-49.7), 33.2% (95%CI: 24.6-41.8), 72.0% (95%CI: 69.1-74.9), 48.8% (95%CI: 47.4-50.2), 26.5% (95%CI: 23.0-30.0), and 11.3% (95%CI: 10.3-12.3). The 5-year survival rates of patients in the training set from stage I to stage IIIC were 80.4%, 72.9%, 59.8%, 48.4%, 32.5%, and 15.0%, according to the TNM + LNR (TNRM) staging system. According to the AJCC staging system, the 5-year survival rates of patients in the validation set from stage I to stage IIIC were 91.3%, 90.8%, 72.6%, 61.3%, 72.4%, 58.1%, and 32.8%. Based on the TNRM staging system, the 5-year survival rates of patients in the validation set from stage I to stage IIIC were 99.2%, 90.5%, 81.4%, 78.6%, 60.2%, and 35.8%.
The TNRM staging system successfully eliminated "survival paradox" in the AJCC staging system, which might be superior to the AJCC staging system.
本研究旨在构建一种基于淋巴结比率（LNR）的结直肠癌（CRC）新分期系统，作为美国癌症联合委员会（AJCC）肿瘤淋巴结转移（TNM）分期系统的补充，用于预测淋巴结数量<12枚的CRC患者的预后。
从监测、流行病学和最终结果（SEER）数据库中提取26695例淋巴结数量<12枚的CRC患者的数据作为训练集。另外，招募了635例来自扬州大学附属苏北人民医院的CRC患者作为独立验证集。采用分类与回归树分析来获取LNR临界值。使用Kaplan-Meier方法估计生存曲线，并采用对数秩检验比较生存曲线之间的差异。分期系统中总生存曲线的单调下降趋势用线性相关度R表示。
在训练集中，基于AJCC分期系统，I期至IV期患者的5年生存率分别为75.6%（95%CI：74.4 - 76.8）、59.8%（95%CI：58.6 - 61.0）、42.1%（95%CI：34.5 - 49.7）、33.2%（95%CI：24.6 - 41.8）、72.0%（95%CI：69.1 - 74.9）、48.8%（95%CI：47.4 - 50.2）、26.5%（95%CI：23.0 - 30.0）和11.3%（95%CI：10.3 - 12.3）。根据TNM + LNR（TNRM）分期系统，训练集中I期至IIIC期患者的5年生存率分别为80.4%、72.9%、59.8%、48.4%、32.5%和15.0%。在验证集中，根据AJCC分期系统，I期至IIIC期患者的5年生存率分别为91.3%、90.8%、72.6%、61.3%、72.4%、58.1%和32.8%。基于TNRM分期系统，验证集中I期至IIIC期患者的5年生存率分别为99.2%、90.5%、81.4%、78.6%、60.2%和35.8%。
TNRM分期系统成功消除了AJCC分期系统中的“生存悖论”，可能优于AJCC分期系统。
