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  

Comparison of three lymph node staging systems in predicting overall survival for gastric cancer patients after radical resection

作　　者：骆彩冰 张冠荣[2] 王玮[3] 周志伟[3] 张晋昕[1] 

机构地区：[1]中山大学公共卫生学院,广州510080 [2]广东省人民医院健康管理(体检)中心,广州510080 [3]中山大学肿瘤防治中心胃胰科华南肿瘤学国家重点实验室肿瘤医学协同创新中心,广州510060

出　　处：《中华胃肠外科杂志》2016年第10期1107-1112,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省自然科学基金（2叭5A030313089）;广州市产学研协同创新重大专项（201508030042）

摘　　要：目的比较淋巴结转移数目（pN）、淋巴结转移率（Nr）和阳性淋巴结对数比（LODDS）这3种淋巴结（N）分期方案对胃癌术后患者生存状况的预测价值。方法回顾性分析2000年1月至2010年12月期间在中山大学肿瘤防治中心行手术切除并具有完整随访信息的1796例胃癌患者的临床病理资料。所有患者分别按照pN、Nr和LODDS3种淋巴结分期方案进行N分期。采用Cox比例风险模型分析3种N分期与患者预后的相关性，比较对应模型的似然比x^2变化值（△x^2）以评价三者的判别效果．变化值大提示效果好：采用log-rank检验比较同一N分期内另外两种N分期的亚组患者5年生存率的差异；通过亚组分析评估淋巴结清扫数目对N分期预后预测效果的影响，以比较其临床应用的稳定性。结果全组1796例胃癌患者淋巴结检查总数为（21．1±12．1）枚，其中阳性淋巴结数为（7．9±8．2）枚，术后中位生存时间为45（95％CI：42．6～47．4）月，5年生存率为55．0％（95％CI：52．6％～57．4％）。Nr分期的似然比△x^2为198．546，高于pN分期（191．255）和LODDS分期（196．557）。除了pN3b外，其他pN分期中，不同Nr亚分期患者5年生存率的差异均有统计学意义（均P〈0．05）；而同一Nr分期中不同pN亚分期患者的5年生存率相近（均P〉0．05）。同一pN分期中不同LODDS亚分期患者5年生存率的差异均有统计学意义（均P〈0．05）；而除了LODDS3分期外．其他LODDS分期中不同pN亚分期患者5年生存率的差异均无统计学意义（均P〉0．05）。在各pN亚分期中，淋巴结检查数目不足（≤15枚）者的死亡风险（HR值）均高于检查数目充足（〉15枚）者（均P〈0．05）；而在Nr和LODDS亚分期中未见类似现象（均P〉0．05）。结论与pN分期方案比较，Nr和LODDS分期、尤其是前者，具有更好的预后评估能力，在临床应用E更稳定。Objectives To compare the prognostic value of three lymph node （N） staging systems, including the number of metastatic lymph nodes （pN）, the metastatic lymph node ratio （Nr） and the log odds of positive lymph nodes （LODDS）, in gastric cancer patients after radical resection. Methods Clinical and pathological data of 1 796 patients who underwent gastric cancer radical resection with complete follow-up information from January 2000 to December 2010 at Sun Yat-sen University Cancer Center were retrospectively analyzed. For each patient, N stages were classified according to three lymph node staging systems （pN, Nr, and LODDS）. The relationship between each N staging was examined. Survival was analyzed using the Cox＇s proportional hazard model, and discrimination of staging system was determined using the change value of Chi squared statistic （AX2） from the log-likelihood test. A larger △x^2 value indicates a better discriminatory ability. The homogeneity of 5-year overall survival across each pN stage within each Nr and LODDS stage was compared by using the log-rank test. The subgroup analysis was performed to evaluate whether each of the competing system was affected by the number of lymph nodes retrieved. Results The mean number of lymph node examined and positive nodes in the entire cohort was 21.1 ± 12.1 and 7.9 ± 8.2, respectively. The median overall survival of all the patients was 45 months （95% CI： 42.6 to 47.4 months）, and the 5-year survival rate was 55.0%（95% CI： 52.6% to 57.4%）. The △x^2 of Nr system was 198.546, which was higher than that of pN（191.255） and LODDS（196.557） system. Except for the pN3b stage, significant heterogeneity was found among patients of different Nr subcategories in 5-year overall survival rate （all P 〈 0.05） within each pN stage. While there was no significant difference in overall survival when any of the Nr stages was stratified by pN stages （all P 〉 0.05）. Significant difference in survival among patients of diffe

关 键 词：胃肿瘤 肿瘤分期 淋巴结 预后 

分 类 号：R735.2[医药卫生—肿瘤]