Division of Digestive Surgery (Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, 602- 8566, Kyoto, Japan.
BMC Cancer. 2023 Mar 8;23(1):218. doi: 10.1186/s12885-023-10689-6.
Adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Lymph node metastasis is an important clinical issue in AEG patients. This study investigated the usefulness of a positive lymph node ratio (PLNR) to stratify prognosis and evaluate stage migration.
We retrospectively analysed 117 consecutive AEG patients (Siewert type I or II) who received a lymphadenectomy between 2000 and 2016.
A PLNR cut-off value of 0.1 most effectively stratified patient prognosis into two groups (P < 0.001). Also, prognosis could be clearly stratified into four groups: PLNR = 0, 0 < PLNR < 0.1, 0.1 ≤ PLNR < 0.2, and 0.2 ≤ PLNR (P < 0.001, 5-year survival rates (88.6%, 61.1%, 34.3%, 10.7%)). A PLNR ≥ 0.1 significantly correlated with tumour diameter ≥ 4 cm (P < 0.001), tumour depth (P < 0.001), greater pathological N-status (P < 0.001), greater pathological Stage (P < 0.001), and oesophageal invasion length ≥ 2 cm (P = 0.002). A PLNR ≥ 0.1 was a poor independent prognostic factor (hazard ratio 6.47, P < 0.001). The PLNR could stratify prognosis if at least 11 lymph nodes were retrieved. A 0.2 PLNR cut-off value discriminated a stage migration effect in pN3 and pStage IV (P = 0.041, P = 0.015) patients; PLNR ≥ 0.2 might potentially diagnose a worse prognosis and need meticulous follow-up post-surgery.
Using PLNR, we can evaluate the prognosis and detect higher malignant cases who need meticulous treatments and follow-up in the same pStage.
食管胃结合部腺癌（AEG）在全球范围内呈上升趋势。淋巴结转移是 AEG 患者的一个重要临床问题。本研究旨在探讨阳性淋巴结比率（PLNR）在分层预后和评估分期迁移方面的作用。
我们回顾性分析了 2000 年至 2016 年间接受淋巴结清扫术的 117 例 AEG 患者（Siewert Ⅰ型或Ⅱ型）。
PLNR 截断值为 0.1 时，能最有效地将患者的预后分为两组（P<0.001）。此外，预后也可以分为四组：PLNR=0、0<PLNR<0.1、0.1≤PLNR<0.2 和 0.2≤PLNR（P<0.001，5 年生存率分别为 88.6%、61.1%、34.3%和 10.7%）。PLNR≥0.1 与肿瘤直径≥4cm（P<0.001）、肿瘤深度（P<0.001）、较大的病理 N 分期（P<0.001）、较大的病理分期（P<0.001）和食管侵犯长度≥2cm（P=0.002）显著相关。PLNR≥0.1 是一个不良的独立预后因素（危险比 6.47，P<0.001）。如果至少检出 11 个淋巴结，PLNR 可用于分层预后。0.2 的 PLNR 截断值可以区分 pN3 和 pStage IV 患者的分期迁移效应（P=0.041，P=0.015）；PLNR≥0.2 可能提示预后更差，术后需要进行细致的随访。
使用 PLNR，我们可以评估预后，并发现需要更细致治疗和随访的高恶性病例，即使在相同的 pStage 中也是如此。
