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淋巴结比率可精确预测食管癌术后放疗的获益:一项回顾性队列研究。

Lymph node ratio precisely predicts the benefit of postoperative radiotherapy in esophageal cancer: A retrospective cohort study.

作者信息

Liang Yuehui, Jian Qinghong, Deng Ming-Gang, Yi Zongbi, Peng Chan, Lu Chunsheng, Yang Huan, Liu Jinyi

机构信息

Institute of Toxicology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, 400038, China; School of Public Health, Wuhan University, Wuhan, 430064, China.

The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, 646000, China.

出版信息

Asian J Surg. 2023 Sep;46(9):3680-3686. doi: 10.1016/j.asjsur.2023.03.160. Epub 2023 Apr 13.


DOI:10.1016/j.asjsur.2023.03.160
PMID:37059676
Abstract

BACKGROUND: The matter of postoperative radiotherapy (PORT) in esophageal cancer (ESCA) was far from conclusive. Some evidence indicated that lymph node status could affect treatment. We evaluated lymph node ratio (LNR) as an indicator that could be applied to predict PORT benefit. METHODS: Retrospective cohort study collected the data of N1, N2, N3 stage ESCA patients from the Surveillance, Epidemiology, and End Results database (SEER) to analyze the association between LNR and prognosis from 2004 to 2015. Patients were categorized into two subsets based on the LNR cut-off value of 0.23 using receiver operating characteristic curve (ROC). Kaplan-Meier analysis was utilized to estimate the proportion of overall survival (OS) and esophagus cancer-specific survival (CSS) in two LNR groups. Cox regression analysis and competitive risk model was adopted to investigate the impacts of LNR on prognosis. RESULTS: Of 2,165 ESCA patients identified, 1,165 (53.8%) had LNR>0.23. The LNR was an independent prognostic factor and associated with better OS and CSS of LNR≤0.23 (P < 0.001). In competitive risk model, a worse CSS was analyzed of LNR>0.23 (HR = 1.71; 95% CI 1.53-1.91). Subgroup analyses indicated that PORT was associated with favorable OS and CSS. Furthermore, when stratified by Node stage, PORT was associated with a survival benefit only in N1 stage with higher LNR (LNR>0.23) after adjusting for other covariates. CONCLUSIONS: LNR exceeding 0.23 was negatively associated with prognosis in ESCA. The survival benefit from PORT in ESCA seems to be limited to LNR of 23% or more only in N1 stage. This study highlights the biomarker meaning of LNR on identifying PORT beneficiary in N1 stage.

摘要

背景:食管癌术后放疗(PORT)的问题尚无定论。一些证据表明淋巴结状态可能影响治疗效果。我们评估了淋巴结比率(LNR)作为一种可用于预测PORT获益的指标。 方法:回顾性队列研究收集了2004年至2015年监测、流行病学和最终结果数据库(SEER)中N1、N2、N3期食管癌患者的数据,以分析LNR与预后的关系。使用受试者工作特征曲线(ROC)将LNR临界值设为0.23,将患者分为两个亚组。采用Kaplan-Meier分析估计两个LNR组的总生存期(OS)和食管癌特异性生存期(CSS)的比例。采用Cox回归分析和竞争风险模型研究LNR对预后的影响。 结果:在纳入的2165例食管癌患者中,1165例(53.8%)的LNR>0.23。LNR是一个独立的预后因素,与LNR≤0.23患者更好的OS和CSS相关(P<0.001)。在竞争风险模型中,分析得出LNR>0.23患者的CSS较差(HR=1.71;95%CI 1.53-1.91)。亚组分析表明,PORT与良好的OS和CSS相关。此外,按淋巴结分期分层时,在调整其他协变量后,PORT仅在LNR较高(LNR>0.23)的N1期患者中与生存获益相关。 结论:LNR超过0.23与食管癌预后呈负相关。食管癌PORT的生存获益似乎仅限于N1期LNR为23%或更高的患者。本研究强调了LNR在识别N1期PORT受益患者中的生物标志物意义。

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Lymph node ratio precisely predicts the benefit of postoperative radiotherapy in esophageal cancer: A retrospective cohort study.

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引用本文的文献

[1]
Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis.

Ann Surg Open. 2025-6-13

[2]
Evaluation of the association between lymph node ratio and long-term survival in patients after surgery for lymph node-positive bladder cancer: a SEER population-based study with external validation.

BMC Cancer. 2025-1-23

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