Wang Ye, Cai Huajun, Zhang Yiyi, Zhuang Jinfu, Liu Xing, Guan Guoxian
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.
Front Surg. 2022 Oct 21;9:961982. doi: 10.3389/fsurg.2022.961982. eCollection 2022.
In the current tumor-lymph node-metastasis (TNM) staging system for colon neuroendocrine tumors, lymph node status is divided into N1 and N0. An assessment of the lymph node ratio (LNR) and a proposal for a modified mTNM staging system were the objectives of this study.
Selecting the optimal cut-off value of LNR was done using X-tile. A Cox regression model and the Kaplan-Meier method were performed to calculate patient cancer-specific survival in the Surveillance, Epidemiology and End Results cohort. Recursive partitioning analysis was used to improve TNM staging.
The study included 674 patients. The current TNM staging system showed inadequate discriminatory power between stage I and stage II patients ( = 0.088). The optimal cut-off value was determined as 0.6 for LNR. Based on multivariate Cox regression analysis, the modified mN classification could be classified into mN 0 (LNR = 0.00), mN 1 (LNR = 0.01-0.60), and mN 2 (LNR > 0.60), and was found to be an independent factor affecting prognosis ( < 0.001). Using the American Joint Committee on Cancer T and modified mN classifications, the modified mTNM system was constructed, and it exhibited better prognostic discriminatory power ability than the traditional TNM system (C-index: 0.587 vs. 0.665).
Our study determined that LNR is a prognostic factor in colon NET patients. In addition, to more accurately assess the prognosis of colon NET patients, we proposed a modified mTNM staging system.
在当前用于结肠神经内分泌肿瘤的肿瘤-淋巴结-转移（TNM）分期系统中，淋巴结状态分为N1和N0。本研究的目的是评估淋巴结比率（LNR）并提出改良的mTNM分期系统。
使用X-tile软件选择LNR的最佳截断值。在监测、流行病学和最终结果队列中，采用Cox回归模型和Kaplan-Meier方法计算患者的癌症特异性生存率。采用递归划分分析改进TNM分期。
该研究纳入了674例患者。当前的TNM分期系统在I期和II期患者之间显示出不足的区分能力（=0.088）。确定LNR的最佳截断值为0.6。基于多变量Cox回归分析，改良的mN分类可分为mN 0（LNR = 0.00）、mN 1（LNR = 0.01 - 0.60）和mN 2（LNR > 0.60），并且被发现是影响预后的独立因素（< 0.001）。使用美国癌症联合委员会的T分类和改良的mN分类，构建了改良的mTNM系统，其预后区分能力优于传统的TNM系统（C指数：0.587对0.665）。
我们的研究确定LNR是结肠神经内分泌肿瘤患者的预后因素。此外，为了更准确地评估结肠神经内分泌肿瘤患者的预后，我们提出了一种改良的mTNM分期系统。
