Liao Shan, Liao Ruizhe, Wu Huaxing, Wang Shijie, Zhou Yanming
Department of General Surgery, First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China.
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Front Oncol. 2023 Aug 11;13:1149211. doi: 10.3389/fonc.2023.1149211. eCollection 2023.
The number of metastatic lymph nodes (MLNs) is not considered in the nodal status (N classification) of intrahepatic cholangiocarcinoma (ICC) in the current 8Edition of the American Joint Committee on Cancer (AJCC) staging system. The aim of this study was to find out the optimal cut-off point based on the number of MLNs and establish a modified AJCC staging system for ICC according to the new N category.
A total of 675 ICC patients diagnosed between 2004 and 2015 were retrieved from the Surveillance, Epidemiology and End Results (SEER) database. The optimal cut-off value of MLNs affecting survival was determined by X-tile software. The relative discriminative power was assessed by Harrell's concordance index (C-index) and Akaike information criterion (AIC).
The proposed new nodal category subdivided patients into three groups (N0, no MLN; N1, 1-3 MLNs; and N2, ≥ 4 MLNs) with significantly different overall survival ( < 0.001). Multivariable analysis revealed that the new nodal category was an independent prognostic factor ( < 0.001). Both the C-index and AIC for our modified staging system were better than those for the 8 AJCC edition (0.574 [95% confidence interval 0.533-0.615] 0.570 [95% confidence interval 0.527-0.613], and 853.30 854.21, respectively).
The modified AJCC staging system based on the number of MLNs may prove to be a useful alternative for predicting survival of ICC patients in clinical practice.
美国癌症联合委员会（AJCC）第8版分期系统中，肝内胆管癌（ICC）的淋巴结状态（N分类）未考虑转移淋巴结（MLNs）的数量。本研究旨在基于MLNs数量找出最佳截断点，并根据新的N类别建立改良的AJCC ICC分期系统。
从监测、流行病学和最终结果（SEER）数据库中检索出2004年至2015年间诊断的675例ICC患者。通过X-tile软件确定影响生存的MLNs最佳截断值。通过Harrell一致性指数（C-index）和赤池信息准则（AIC）评估相对判别力。
提出的新淋巴结类别将患者分为三组（N0，无MLN；N1，1 - 3个MLN；N2，≥4个MLN），总生存期有显著差异（<0.001）。多变量分析显示新淋巴结类别是独立的预后因素（<0.001）。我们改良分期系统的C-index和AIC均优于AJCC第8版（分别为0.574 [95%置信区间0.533 - 0.615] 对0.570 [95%置信区间0.527 - 0.613]，以及853.30对854.21）。
基于MLNs数量的改良AJCC分期系统可能在临床实践中成为预测ICC患者生存的有用替代方法。
