4种淋巴结分期方法对进展期胃癌根治术后患者预后的评估价值比较
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摘要
目的比较淋巴结转移数(p N)、淋巴结转移率(MLR)、阴性淋巴结数(NLNC)、阳性淋巴结对数比(LODDS) 4种淋巴结分期方法对于进展期胃癌根治术后患者预后的评估价值。方法回顾性分析2010年6月至2013年5月于安徽医科大学附属省立医院接受标准胃癌根治术治疗的241例进展期胃癌患者的临床资料,按照p N、MLR、NLNC、LODDS 4种淋巴结分期方法的分组标准对241例患者分别进行分组,比较p N、MLR、NLNC、LODDS 4种淋巴结分期方式分组的患者术后5年生存率的差异,使用Kaplan-Merier生存分析进行单因素分析,Log-rank比较组间差异,Cox比例风险模型比较p N、MLR、NLNC、LODDS 4种淋巴结分期方法与患者预后的相关性并判断四者的评估价值优劣。结果按照4种不同的淋巴结分期方法 p N(P <0. 05)、MLR(P <0. 05)、NLNC(P <0. 05)、LODDS(P <0. 05)进行分组的进展期胃癌患者5年生存率差异有统计学意义。单因素分析结果表明:年龄、手术方式、肿瘤部位、肿瘤大小、肿瘤浸润深度、大体分型、分化类型、淋巴结清扫总数等是影响胃癌患者预后的关键因素。Cox多因素分析p N、MLR、NLNC和LODDS 4种淋巴结分期方法对应的似然比△χ2值分别为3. 539、7. 812、14. 780、6. 161,显然MLR、NLNC和LODDS分期要高于p N分期,其中NLNC对应的似然比△χ2值最高。结论与p N分期方法相比,MLR、NLNC和LODDS分期方法,尤其是NLNC具备更好的预后评估价值。
Objective To compare the prognostic value of four lymph node staging strategies,including the number of metastatic lymph nodes(p N),metastastic lymph nodes ratio(MLR),negative lymph node count(NLNC) and log odds of positive lymph nodes(LODDS),in advanced gastric cancer patients. Methods Retrospective analysis was performed on the clinical data of 241 patients with advanced gastric cancer who underwent radical gastrectomy in the Provincial Hospital of Anhui Medical University from June 2010 to May 2013.All 241 patients were grouped according to the grouping criteria of p N,MLR,NLNC,and LODDS lymph node staging methods. Patients were compared in groups with p N,MLR,NL NC,LODDS lymph node staging methods in terms of the difference in 5-year survival rate,using Kaplan-Merier survival analysis for univariate analysis,Log-rank comparison between groups. The Cox proportional hazard model was used to compare the correlations between the four lymph node staging methodsof p N,MLR,NLNC and LODDS and the prognosis of patients,and the evaluation value of the four methods was judged. Results The 5-year survival rates of patients with advanced gastric cancer were significantly different according to four different lymph node staging methods: p N(P < 0. 05),MLR(P < 0. 05),NLNC(P <0. 05),and LODDS(P < 0. 05). Univariate analysis showed that the factors affecting the prognosis of patients with advanced gastric cancer included age,surgical approach,tumor location,tumor size,depth of tumor invasion(Tx),gross classification,differentiation type,and total lymph node dissection. Cox multivariate analysis showed that likelihood ratios of Δχ2 for p N,MLR,NLNC,and LODDS were 3. 539,7. 812,14. 780,and 6. 161. Obviously,the MLR,NLNC,and LODDS stages were higher than the p N stage,and NLNC corresponding likelihood ratio of Δχ2 was the highest. Conclusion Compared with p N staging methods,MLR,NLNC,and LODDS staging methods,especially NLNC,have better prognostic evaluation value.
Objective To compare the prognostic value of four lymph node staging strategies,including the number of metastatic lymph nodes(p N),metastastic lymph nodes ratio(MLR),negative lymph node count(NLNC) and log odds of positive lymph nodes(LODDS),in advanced gastric cancer patients. Methods Retrospective analysis was performed on the clinical data of 241 patients with advanced gastric cancer who underwent radical gastrectomy in the Provincial Hospital of Anhui Medical University from June 2010 to May 2013.All 241 patients were grouped according to the grouping criteria of p N,MLR,NLNC,and LODDS lymph node staging methods. Patients were compared in groups with p N,MLR,NL NC,LODDS lymph node staging methods in terms of the difference in 5-year survival rate,using Kaplan-Merier survival analysis for univariate analysis,Log-rank comparison between groups. The Cox proportional hazard model was used to compare the correlations between the four lymph node staging methodsof p N,MLR,NLNC and LODDS and the prognosis of patients,and the evaluation value of the four methods was judged. Results The 5-year survival rates of patients with advanced gastric cancer were significantly different according to four different lymph node staging methods: p N(P < 0. 05),MLR(P < 0. 05),NLNC(P <0. 05),and LODDS(P < 0. 05). Univariate analysis showed that the factors affecting the prognosis of patients with advanced gastric cancer included age,surgical approach,tumor location,tumor size,depth of tumor invasion(Tx),gross classification,differentiation type,and total lymph node dissection. Cox multivariate analysis showed that likelihood ratios of Δχ2 for p N,MLR,NLNC,and LODDS were 3. 539,7. 812,14. 780,and 6. 161. Obviously,the MLR,NLNC,and LODDS stages were higher than the p N stage,and NLNC corresponding likelihood ratio of Δχ2 was the highest. Conclusion Compared with p N staging methods,MLR,NLNC,and LODDS staging methods,especially NLNC,have better prognostic evaluation value.
引文
[1]杜敏,曾永庆,涂从银,等.胃癌根治术后并发症及其危险因素分析[J].安徽医学,2016,37(6):693-695.
[2] AMIN M B,GREENE F L,EDGE S B,et al. The eighth edition AJCC cancer staging manual:continuing to build adridge from a population-based to a more “personalized”approach to cancer staging[J]. CA Cancer J Clin,2017,67(2):93-99.
[3] JYE J N,REN Y F,WEI Z W,et al. External validation of a modified 8th AJCC TNM system for advanced gastric cancer:Long-term results in southern China[J]. Surgical Oncology,2018,27(2):146-153.
[4] SZCZEPANIK A M,PASZKO A,SZURA M,et al. Alternative staging of regional lymph nodes in gastric cancer[J]. Prz Gastroenterol,2016,11(3):145-149.
[5]骆彩冰,张冠荣,王玮,等.三种淋巴结分期方案对胃癌根治术后患者预后评估价值的对比分析[J].中华胃肠外科杂志,2016,19(10):1107-1112.
[6]郗洪庆,张珂诚,卫勃,等.胃癌TNM分期第八版更新在临床诊断治疗中的意义和思考[J].中华胃肠外科杂志,2017,20(2):166-170.
[7]冯润华,朱正纲,燕敏,等.淋巴结转移率对T2-T3期胃癌患者预后评估的价值[J].中华胃肠外科杂志,2007,10(5):431-435.
[8]蒋楠,邓靖宇,丁学伟,等.阴性淋巴结数目在T3期胃癌预后中的价值[J].中华普通外科杂志,2014,29(6):412-415.
[9] SUN Z,XU Y,LI D M,et al. Log odds of positive lymph nodes:a novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0ressction[J]. Cancer,2010,116(11):2571-2580.
[10]陈孝平,汪建平.外科学[M]. 8版.北京:人民卫生出版社,2013:362.
[11]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.
[12] CAI J,IKEGUCHI M,MAETA M,et al. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer[J]. Surgery,2000,127(1):32-39.
[13] KATTAN M W,KARPEH M S,MAZUMDAR M,et al. Postoperative nomogram for disease-specific survival after an R0resection for gastric carcinoma[J]. J Clin Oncol,2003,(21):3647-3650.
[14] DENG J,LIANG H,WANG D,et al. Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes[J]. Ann Surg Oncol,2010,17(4):1043-1051.
[15] HUANG C M,LIN J X,ZHENG C H,et al. Effect of negative lymph node count on survival for gastric cancer after curative distal gastrectomy[J]. Eur J Surg Oncol,2011,37(6):481-487.
[2] AMIN M B,GREENE F L,EDGE S B,et al. The eighth edition AJCC cancer staging manual:continuing to build adridge from a population-based to a more “personalized”approach to cancer staging[J]. CA Cancer J Clin,2017,67(2):93-99.
[3] JYE J N,REN Y F,WEI Z W,et al. External validation of a modified 8th AJCC TNM system for advanced gastric cancer:Long-term results in southern China[J]. Surgical Oncology,2018,27(2):146-153.
[4] SZCZEPANIK A M,PASZKO A,SZURA M,et al. Alternative staging of regional lymph nodes in gastric cancer[J]. Prz Gastroenterol,2016,11(3):145-149.
[5]骆彩冰,张冠荣,王玮,等.三种淋巴结分期方案对胃癌根治术后患者预后评估价值的对比分析[J].中华胃肠外科杂志,2016,19(10):1107-1112.
[6]郗洪庆,张珂诚,卫勃,等.胃癌TNM分期第八版更新在临床诊断治疗中的意义和思考[J].中华胃肠外科杂志,2017,20(2):166-170.
[7]冯润华,朱正纲,燕敏,等.淋巴结转移率对T2-T3期胃癌患者预后评估的价值[J].中华胃肠外科杂志,2007,10(5):431-435.
[8]蒋楠,邓靖宇,丁学伟,等.阴性淋巴结数目在T3期胃癌预后中的价值[J].中华普通外科杂志,2014,29(6):412-415.
[9] SUN Z,XU Y,LI D M,et al. Log odds of positive lymph nodes:a novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0ressction[J]. Cancer,2010,116(11):2571-2580.
[10]陈孝平,汪建平.外科学[M]. 8版.北京:人民卫生出版社,2013:362.
[11]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.
[12] CAI J,IKEGUCHI M,MAETA M,et al. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer[J]. Surgery,2000,127(1):32-39.
[13] KATTAN M W,KARPEH M S,MAZUMDAR M,et al. Postoperative nomogram for disease-specific survival after an R0resection for gastric carcinoma[J]. J Clin Oncol,2003,(21):3647-3650.
[14] DENG J,LIANG H,WANG D,et al. Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes[J]. Ann Surg Oncol,2010,17(4):1043-1051.
[15] HUANG C M,LIN J X,ZHENG C H,et al. Effect of negative lymph node count on survival for gastric cancer after curative distal gastrectomy[J]. Eur J Surg Oncol,2011,37(6):481-487.