评估食管胃结合部腺癌中阳性淋巴结比率的预后价值和分期迁移效应。

Evaluating prognostic value and stage migration effects using a positive lymph node ratio in adenocarcinoma of the esophagogastric junction.

机构信息

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.

出版信息

BMC Cancer. 2023 Mar 8;23(1):218. doi: 10.1186/s12885-023-10689-6.

DOI:10.1186/s12885-023-10689-6

PMID:36890486

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9996992/

Abstract

BACKGROUND

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.

METHODS

We retrospectively analysed 117 consecutive AEG patients (Siewert type I or II) who received a lymphadenectomy between 2000 and 2016.

RESULTS

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.

CONCLUSION

Using PLNR, we can evaluate the prognosis and detect higher malignant cases who need meticulous treatments and follow-up in the same pStage.

摘要

背景

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。

方法

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）。

结果

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。