淋巴结转移率对食管胃交界部腺癌患者的预后评估价值  

Prognostic value of metastatic lymph node ratio in adenocarcinoma of the gastroesophageal junction

作　　者：张洪典[1] 马钊[1] 唐鹏[1] 段晓峰[1] 任鹏[1] 岳杰[1] 于振涛[1] 

机构地区：[1]天津医科大学附属肿瘤医院食管肿瘤科天津市肿瘤防治重点实验室,300060

出　　处：《中华胃肠外科杂志》2013年第9期822-826,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81071981）

摘　　要：目的 比较AJCC/UICC胃癌淋巴结（pN）分期与淋巴结转移率（MLR）分期及以其为基础的TNM与TRM分期系统对食管胃交界部腺癌患者的预后评估价值.方法 回顾性分析天津市肿瘤医院2000年1月至2007年6月间行根治性切除手术的414例食管胃交界部腺癌的临床资料.采用Spearman相关分析检验 pN、MLR与送检淋巴结数3者之间的相关性；应用单因素KaplanMeier生存分析和多因素Cox回归分析检验pN、MLR、TNM及TRM分期与患者预后的关系；通过ROC曲线下面积（AUC）比较它们对患者5年生存率的预测价值.结果 414例患者中位淋巴结清扫数目17（4～71）枚/例,中位转移淋巴结数目4（0～67）枚/例.阳性淋巴结数与淋巴结清扫数目呈正相关 （P＜0.01）,MLR与淋巴结清扫数目无相关性（P＞0.05）.单因素和多因素预后分析结果表明,pN和MLR均可单独作为食管胃交界部腺癌患者的独立预后因素（均P＜0.01）,且MLR的相对危险度（HR）值高于pN（1.573比1.382）；但当pN与MLR共同纳入多因素分析时,MLR仍是独立预后因素（P＜0.01）,而pN不再是其独立预后因素（P＞0.05）.MLR和pN预测患者预后所对应的AUC分别为0.726和 0.714,TRM分期和TNM分期所对应的AUC分别为0.747和0.736,差异均无统计学意义（均P＞0.05）.结论 MLR是食管胃交界部腺癌患者的独立预后因素,MLR及以其为基础的TRM分期对食管胃交界部腺癌患者预后的评估价值或优于pN及以其为基础的TNM分期.Objective To compare the prognostic value of AJCC/UICC pN stage with metastatic lymph node ratio （MLR） and the prognostic difference between the tumor-node-metastasis （TNM） stage and tumor-ratio-metastasis （TRM） stage in patients with adenocarcinoma of the gastroesophageal junction.Methods Clinical data of 414 patients with adenocarcinoma of the gastroesophageal junction undergoing curative resection at the Tianjin Medical University Cancer Institute and Hospital from January 2000 to June 2007 were retrospectively reviewed.Spearman correlation analysis was performed to examine the correlations between pN,MLR and retrieved nodes.Univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis were performed to analyze the effects of pN,MLR,TNM and TRM stage on the prognosis of these patients.The area under the ROC curve （AUC） was plotted to compare the value of these stages and to predict the 5-year survival rate.Results The median number of retrieved nodes was 17 （4-71） per patient,and the median number of positive nodes was 4（0-67） per patient.The number of metastatic lymph node was positively correlated with that of retrieved nodes（P〈0.01）,but MLR was not correlated with the number of retrieved nodes（P〉0.05）.Univariate and multivariate survival analysis showed that either pN or MLR could be used as an independent risk factor for survival （P〈0.01） and the hazard ratio of MLR stage was larger than that of pN stage （1.573 vs 1.382）.While pN and MLR were entered into the Cox hazard ratio model as covariates at the same time,MLR remained as the independent prognostic factor （P〈0.01）,but pN lost significance （P〉0.05）.The AUC of MLR and pN staging was 0.726 and 0.714,and of TRM and TNM staging was 0.747 and 0.736,respectively,however the differences were not statistically significant （all P〉0.05）.Conclusions MLR is an independent prognostic factor for patients with adenocarcinoma of the gastroesophageal junction.The value

关 键 词：食管胃交界部腺癌 淋巴结转移率 TRM分期 预后 

分 类 号：R735.1[医药卫生—肿瘤]