Department of Pharmacy, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China.
Department of Education, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, People's Republic of China.
BMJ Open. 2023 Apr 26;13(4):e068044. doi: 10.1136/bmjopen-2022-068044.
To compare the prognostic values of three lymph node staging systems in renal cell carcinoma (RCC), including the number of positive lymph nodes (NPLN), lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS).
A retrospective cohort study using data from the Surveillance, Epidemiology and End Results (SEER) database.
1904 patients with pathological N1 RCC, diagnosed from 2004 to 2015 and underwent nephrectomy combined with lymph node dissection, were identified from the SEER database.
The primary outcome of this study was overall survival (OS). Restricted cubic spline functions and multivariable Cox regression analyses were employed to characterise the associations of OS with NPLN, LNR and LODDS, respectively.
Data of 1904 eligible RCC patients were extracted from the SEER database. The mortality risks of RCC patients increased with the increasing of NPLN, LNR and LODDS. NPLN (NPLN3 vs NPLN1, HR 1.22, 95% CI 1.05 to 1.43, p=0.001), LNR (LNR3 vs LNR1, HR 1.46, 95% CI 1.28 to 1.67, p<0.001; LNR2 vs LNR1, HR 1.28, 95% CI 1.09 to 1.50, p=0.002) and LODDS (LODDS3 vs LODDS1, HR 1.48, 95% CI 1.28 to 1.72, p<0.001; LODDS2 vs LODDS1, HR 1.34, 95% CI 1.17 to 1.53, p<0.001) were all independent prognostic factors of OS. The predictive abilities of LNR (Akaike information criterion, AIC: 19576.3, optimism-corrected C-index: 0.677) and LODDS (AIC: 19579.2, optimism-corrected C-index: 0.676) were comparable, superior to NPLN (AIC: 19603.7, optimism-corrected C-index: 0.673). In subgroup analyses, the LODDS classification could better stratify survival of RCC patients, in particular for those with the number of dissected lymph nodes <13 or NPLN≤2.
NPLN, LNR and LODDS were all independent predictors of OS in RCC. When compared with NPLN and LNR, LODDS had a better performance in survival prediction and risk stratification. The three metrics all had the potential to be integrated into future versions of the American Joint Committee on Cancer staging manual.
比较三种用于肾细胞癌（RCC）的淋巴结分期系统的预后价值，包括阳性淋巴结数量（NPLN）、淋巴结比例（LNR）和阳性淋巴结对数优势比（LODDS）。
使用来自监测、流行病学和最终结果（SEER）数据库的数据进行回顾性队列研究。
从 SEER 数据库中确定了 2004 年至 2015 年间接受肾切除术联合淋巴结清扫术治疗的 1904 例病理 N1 RCC 患者。
本研究的主要结局是总生存（OS）。采用受限立方样条函数和多变量 Cox 回归分析分别描述 OS 与 NPLN、LNR 和 LODDS 的关联。
从 SEER 数据库中提取了 1904 例符合条件的 RCC 患者的数据。随着 NPLN、LNR 和 LODDS 的增加，RCC 患者的死亡风险增加。NPLN（NPLN3 与 NPLN1，HR 1.22，95%CI 1.05 至 1.43，p=0.001）、LNR（LNR3 与 LNR1，HR 1.46，95%CI 1.28 至 1.67，p<0.001；LNR2 与 LNR1，HR 1.28，95%CI 1.09 至 1.50，p=0.002）和 LODDS（LODDS3 与 LODDS1，HR 1.48，95%CI 1.28 至 1.72，p<0.001；LODDS2 与 LODDS1，HR 1.34，95%CI 1.17 至 1.53，p<0.001）均是 OS 的独立预后因素。LNR（Akaike 信息准则，AIC：19576.3，校正后的 C 指数：0.677）和 LODDS（AIC：19579.2，校正后的 C 指数：0.676）的预测能力相当，优于 NPLN（AIC：19603.7，校正后的 C 指数：0.673）。在亚组分析中，LODDS 分类可更好地分层 RCC 患者的生存情况，尤其是对于淋巴结清扫数<13 或 NPLN≤2 的患者。
NPLN、LNR 和 LODDS 均是 RCC 患者 OS 的独立预测因素。与 NPLN 和 LNR 相比，LODDS 在生存预测和风险分层方面具有更好的性能。这三个指标均有可能被纳入未来的美国癌症联合委员会分期手册版本中。
