不同淋巴结分期方法预测胃癌预后的能力
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摘要
目的:比较第8版美国肿瘤联合会(American Joint Committee on Cancer,AJCC)/国际抗癌联盟(Union for International Cancer Control,UICC)胃癌淋巴结分期(N分期)、淋巴结转移率(metastatic ly mph node ratio,r N)分期和阳性淋巴结对数比(log odds of positive ly mph nodes,LODDS)3种淋巴结分期方法对于接受胃癌根治术后患者预后的预测性能。方法:收集117例2009年1月至2011年12月在安徽医科大学第三附属医院胃肠外科接受胃癌根治术患者的病理及随访数据,并进行受试者工作特征(receiver operating characteristic,ROC)曲线分析。评估不同淋巴结分期方法对于预后的预测性能。结果:总体样本中3种分期方法均有预测性能,而LODDS分期方法的预测性能高于N分期及r N分期;在总体转移淋巴结数为0的样本中,仅LODDS分期有预测性能。而将三者作为连续性变量分析时,预测能力上升。结论:LODDS的预测性能优于N分期及r N分期;当总体转移淋巴结数为0时,仅LODDS分期有预测性能。将淋巴结情况作为连续性变量能更好地评估预后。
Objective: To compare the ability in predicting the prognosis of gastric cancer among the N staging of gastric cancer of the Eighth American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC), the metastatic lymph node ratio(rN) and the log odds of positive lymph nodes(LODDS). Methods: The pathological and follow-up data of 117 gastric cancer patients who received radical operation in Gastrointestinal Surgery of Third Affiliated Hospital of Medical University of Anhui were collected and analyzed with receiver operating characteristic(ROC) curves. The ability of predicting the prognosis of gastric cancer was compared. Results: All the three staging systems have ability in predicting the prognosis of gastric cancer in the overall sample, while the LODDS is better than the N and the rN. Only the LODDS had prognostic value in the sample without lymph node metastasis. And the ability will rise when the date is seen as continuity variables. Conclusion: The ability of LODDS is better than the N and the rN. Only the LODDS had prognostic value in the sample without lymph node metastasis. And the ability will rise when the date is seen as continuity variables.
Objective: To compare the ability in predicting the prognosis of gastric cancer among the N staging of gastric cancer of the Eighth American Joint Committee on Cancer(AJCC)/Union for International Cancer Control(UICC), the metastatic lymph node ratio(rN) and the log odds of positive lymph nodes(LODDS). Methods: The pathological and follow-up data of 117 gastric cancer patients who received radical operation in Gastrointestinal Surgery of Third Affiliated Hospital of Medical University of Anhui were collected and analyzed with receiver operating characteristic(ROC) curves. The ability of predicting the prognosis of gastric cancer was compared. Results: All the three staging systems have ability in predicting the prognosis of gastric cancer in the overall sample, while the LODDS is better than the N and the rN. Only the LODDS had prognostic value in the sample without lymph node metastasis. And the ability will rise when the date is seen as continuity variables. Conclusion: The ability of LODDS is better than the N and the rN. Only the LODDS had prognostic value in the sample without lymph node metastasis. And the ability will rise when the date is seen as continuity variables.
引文
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15 .Spolverato G,Ejaz A,Kim Y,et al.Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma[J].Ann Surg,2015,262(6):991-998.
2 .Okusa T,Nakane Y,Boku T,et al.Quantitative analysis of nodal involvement with respect to survival rate after curative gastrectomy for carcinoma[J].Surg Gynecol Obstet,1990,170(6):488-494.
3 .Marchet A,Mocellin S,Ambrosi A,et al.The prognostic value of N-ratio in patients with gastric cancer:validation in a large,multicenter series[J].Eur J Surg Oncol,2008,34(2):159-165.
4 .Wang J,Dang P,Raut CP,et al.Comparison of a lymph node ratiobased staging system with the 7th AJCC system for gastric cancer:analysis of 18,043 patients from the SEER database[J].Ann Surg,2012,255(3):478-485.
5 .喻存俊,施伟,何雯婷,等.3种淋巴结分期方法对胃癌预后评估准确性的分析[J].南京医科大学学报(自然科学版),2011,31(5):736-741.YU Cunjun,SHI Wei,HE Wenting,et al.Analysis on the prognostic accuracy of three gastric cancer lymph node staging systems[J].Acta Universitatis Medicinalis Nanjing,2011,31(5):736-741.
6 .李瑞,文刚,程元光,等.进展期中上部胃癌脾门淋巴结转移与微转移的分析[J].安徽医学,2016,37(1):34-37.LI Rui,WEN Gang,CHENG Yuanguang,et al.Analysis of splenic hilar lymph node metastasis and micrometastasis for Advanced middle and upper gastric cancer[J].Anhui Medical Journal,2016,37(1):34-37.
7 .汪贯龙,文刚,何磊,等.p T4a N0M0期胃癌预后的影响因素分析[J].安徽医学,2017,38(1):18-21.WANG Guanlong,WEN Gang,HE Lei,et al.Analysis of factors affecting the prognosis of p T4a N0M0 gastric cancer[J].Anhui Medical Journal,2017,38(1):18-21.
8 .向传文.浅论年龄因素对接受胃癌根治术的患者术后5年生存率的影响[J].当代医药论丛,2016,14(11):11-12.XIANG Chuanwen.The influence of age factors on the 5 year survival rate of postoperative patients after radical gastrectomy for gastric cancer[J].Contemporary Medicine Forum,2016,14(11):11-12.
9 .符涛,季加孚.胃癌诊疗的热点和问题[J].中国肿瘤临床,2016,43(1):2-5.FU Tao,JI Jiafu.Hot spots and problems in the diagnosis and treatment of gastric cancer[J].Chinese Journal of Clinical Oncology,2016,43(1):2-5.
10 .Celen O,Yildirim E,Berberoglu U.Prognostic impact of positive lymph node ratio in gastric carcinoma[J].J Surg Oncol,2007,96(2):95-101.
11 .黎焕君,刘琦,陈志良,等.淋巴结转移率对胃癌D2根治术患者的预后分析[J].肿瘤学杂志,2016,22(4):300-304.LI Huanjun,LIU Qi,CHEN Zhi liang.Prognostic analysis of metastatic lymph node ratio in gastric cancer patients with D2 radical gastrectomy[J].Journal of Oncology,2016,22(4):300-304.
12 .封晓昆,韩悦,石英,等.淋巴结转移率对各p T分期胃癌患者生存状况的评估效果[J].中国医学前沿杂志(电子版),2015,7(5):58-60.FENG Xiaokun,HAN Yue,SHI Ying,et al.Prognostic value of living conditions in gastric cancer patients by p T stage[J].Chinese Journal of the Frontiers of Medical Science.Electronic Version,2015,7(5):58-60.
13 .Kutlu OC,Watchell M,Dissanaike S.Metastatic lymph node ratio successfully predicts prognosis in western gastric cancer patients[J].Surg Oncol,2015,24(2):84-88.
14 .Lee SY,Hwang I,Park YS,et al.Metastatic lymph node ratio in advanced gastric carcinoma:a better prognostic factor than number of metastatic lymph nodes?[J].Int J Oncol,2010,36(6):1461-1467.
15 .Spolverato G,Ejaz A,Kim Y,et al.Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma[J].Ann Surg,2015,262(6):991-998.