Wang Zhongshuai, Li Feng, Zhu Mingchuang, Lu Tao, Wen Linqi, Yang Shengzhao, Zhuang Xiaofei, Zhang Shuangping, Ma Yong, Lian Jianhong
Cancer Hospital Affiliated to Shanxi Medical University/ Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China.
Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China.
Front Oncol. 2024 Jun 27;14:1376527. doi: 10.3389/fonc.2024.1376527. eCollection 2024.
Lymph node-based staging protocols are frequently employed to evaluate the prognosis of esophageal cancer, yet their accuracy remains contentious. The present study was conducted to assess the prognostic significance of three lymph node staging systems, namely N stage, lymph node rate (LNR), and log odds of positive lymph nodes (LODDS), in patients diagnosed with advanced (T2-T4) esophageal squamous cell carcinoma (ESCC).
This cohort comprised 319 eligible patients, with an additional 409 individuals retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, forming the validation cohort. Differences in overall survival (OS) of patients between groups were assessed using the log-rank test. Prognostic independent risk variables were identified, and lymph nodes (LN) prognostic models were built using multivariate Cox regression analysis. Besides, the predictive accuracy of each model was evaluated utilizing the (-2) log-likelihood ratio (-2LLR), the likelihood ratio χ2 score (LRχ2), the Akaike information criterion (AIC), and Harrell's concordance index (C-index). To further evaluate the potential superiority of the model, a nomogram was constructed for comparison with the conventional Tumor Node Metastasis (TNM) staging approach.
Independent prognostic factors for advanced ESCC include the N stage, LNR, and LODDS. Herein, LODDS presented higher values for C-index and LRχ2, and lower values for AIC and -2LLR in OS compared to the others. Consequently, a nomogram was constructed based on LODDS. Calibration curves exhibited strong agreement, and assessment through C-index, receiver operating characteristic (ROC) curves, and clinical decision curve analysis (DCA) demonstrated promising clinical applicability.
LODDS emerges as a promising future prognostic indicator. After surgery, the proposed model holds the potential to provide valuable treatment recommendations for patients with advanced ESCC.
基于淋巴结的分期方案常用于评估食管癌的预后，但其准确性仍存在争议。本研究旨在评估三种淋巴结分期系统，即N分期、淋巴结比率（LNR）和阳性淋巴结对数比值（LODDS），对诊断为晚期（T2 - T4）食管鳞状细胞癌（ESCC）患者的预后意义。
该队列包括319例符合条件的患者，另外从监测、流行病学和最终结果（SEER）数据库中检索了409例个体，组成验证队列。使用对数秩检验评估各组患者总生存期（OS）的差异。确定预后独立风险变量，并使用多变量Cox回归分析建立淋巴结（LN）预后模型。此外，利用（-2）对数似然比（-2LLR）、似然比χ2评分（LRχ2）、赤池信息准则（AIC）和哈雷尔一致性指数（C指数）评估每个模型的预测准确性。为进一步评估该模型的潜在优势，构建了列线图以与传统的肿瘤淋巴结转移（TNM）分期方法进行比较。
晚期ESCC的独立预后因素包括N分期、LNR和LODDS。在此，与其他因素相比，LODDS在OS方面的C指数和LRχ2值较高，而AIC和-2LLR值较低。因此，基于LODDS构建了列线图。校准曲线显示出很强的一致性，通过C指数、受试者工作特征（ROC）曲线和临床决策曲线分析（DCA）进行的评估表明其具有良好的临床适用性。
LODDS有望成为未来的预后指标。手术后，所提出的模型有可能为晚期ESCC患者提供有价值的治疗建议。
