A Comparison of Five Competing Lymph Node Staging Schemes in a Cohort of Resectable Gastric Cancer Patients

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• 作者：David D. Smith PhD (1)
  Rebecca A. Nelson PhD (1)
  Roderich E. Schwarz MD ; PhD ; FACS (2) (3)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：21
• 期：3
• 页码：875-882
• 全文大小：612 KB
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• 作者单位：David D. Smith PhD (1)
  Rebecca A. Nelson PhD (1)
  Roderich E. Schwarz MD, PhD, FACS (2) (3)
  
  1. Division of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA
  2. Department of Surgery, Indiana University School of Medicine South Bend, South Bend, IN, USA
  3. IU Health Goshen Center for Cancer Care, Goshen, IN, USA
  
• ISSN：1534-4681

文摘

Background New classifications for lymph node (LN) staging have recently been proposed to improve upon the UICC/AJCC N category staging convention. Ratio-based systems and logarithmic odds (LODDS) scores are two families of novel competing staging systems. We compared UICC/AJCC staging with 5 ratio and LODDS systems in predicting overall survival (OS) in patients with resected gastric cancer. Methods Using a large population-based dataset, we identified 12,184 nonmetastatic resectable gastric cancer patients between 1988 and 2004. We compared each subject’s UICC/AJCC N stage with five novel staging schemes. We analyzed the OS for each method. Our comparison metric was the log-rank Chi squared statistic; larger Chi squared statistics indicate improvements in N stage discrimination. Results Median OS was 2.1?years (95?% CI 2.0-.2?years), while median patient follow-up for surviving patients was 8.3?years (range, 1?month-2?years). Although all 5 staging systems were either comparable or superior to the UICC/AJCC convention, a LN ratio method outperformed others in N stage discrimination based on log-rank tests for OS. This trend was independent of the number of LNs examined. Conclusions Novel LN staging methods have a higher degree of discrimination utility than the UICC/AJCC N convention. These methods may have a role in reducing the prognostic impact of LN count variability. Of the systems assessed, the LN ratio system that assigns greater risk attribution to cases with <16 LNs was the best classification method to predict OS in patients with resectable gastric cancer.