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Title: [The relationship between the index of lymph node metastasis and the prognosis of pancreatic cancer patients after R0 resection].
Author: Ren H, Wang CF.
Journal: Zhonghua Zhong Liu Za Zhi; 2020 Jun 23; 42(6):474-479. PubMed ID: 32575943.
Abstract:
Objective: To investigate the prognostic values of three different staging schemes including the number of lymph node metastasis (N stage), lymph node ratio (LNR) and log odd of positive lymph nodes (LODDS) in pancreatic cancer patients after R0 resection. Methods: The clinical and pathological data of 307 pancreatic cancer patients who underwent R0 resection at Cancer Hospital of Chinese Academy of Medical Sciences from January 2010 to December 2018 were retrospectively analyzed. Kaplan-Meier and Cox proportional hazard regression models were used to analyze the independent prognostic factors. The area under the receiver operator characteristic curve (AUC) was used to compare the prognostic efficacy of different lymph node staging systems. Results: The median survival was 24.0 months, 1-year, 3-year, and 5-year survival rates were 72.0%, 35.5% and 24.0%, respectively. Multivariate analysis showed that CA199, differentiation, T stage, adjuvant therapy, N stage, LNR stage, and LODDS stage were independent prognostic factors for pancreatic cancer patients after R0 resection (P<0.05). The AUC values of the 1-year survival rate for N stage, LNR stage, and LODDS stage were 0.591, 0.592 and 0.609, respectively. The AUC values of the 3-year survival rate for N stage, LNR stage, and LODDS stage were 0.585, 0.588 and 0.593, respectively. The AUC values of the 5-year survival rate for N stage, LNR stage, and LODDS stage were 0.554, 0.557 and 0.589, respectively. The AUC values of the LODDS stage were the highest while the N stage were the lowest, but there was no significant difference among these three systems (P>0.05). For all patients, the LODDS staging system was slightly better than the N and LNR staging systems, but the difference was not statistically significant (P>0.05). For patients with N0 stage, the LODDS staging system showed better prediction performance than the N stage and LNR staging systems (P<0.05). Conclusions: The N stage, LNR stage, and LODDS stage are independent prognostic factors for pancreatic cancer patients after R0 resection. For patients without lymph node metastasis, LODDS staging system is superior to N and LNR staging systems in predicting prognosis. 目的： 探讨淋巴结转移数目(N分期)、淋巴结转移率(LNR)和阳性淋巴结对数比(LODDS)与胰腺癌R0切除术后患者预后的关系。 方法： 回顾性分析2010年1月至2018年12月在中国医学科学院肿瘤医院接受R0切除的307例胰腺癌患者的临床病理资料，以Kaplan－Meier法和Cox比例风险回归模型分析影响患者预后的因素；以受试者工作特征曲线(ROC)的曲线下面积(AUC)比较N分期、LNR分级和LODDS分级预测患者预后的效能。 结果： 全组患者的中位生存时间为24.0个月，1、3和5年生存率分别为72.0%、35.5%和24.0%。多因素分析结果显示，CA199、分化程度、辅助治疗、T分期、N分期、LNR分级以及LODDS分级均是影响R0切除胰腺癌患者预后的独立因素(均P<0.05)。ROC曲线分析结果显示，预测1年生存率时，N分期、LNR分级和LODDS分级的AUC分别为0.591、0.592和0.609；预测3年生存率时，N分期、LNR分级和LODDS分级的AUC分别为0.585、0.588和0.593；预测5年生存率时，N分期、LNR分级和LODDS分级的AUC分别为0.554、0.557和0.589。LODDS分级系统的AUC均最高，N分期的AUC最低，但3种预测手段之间的差异无统计学意义(P>0.05)。针对全组患者，LODDS分级略优于N分期和LNR分级，但差异无统计学意义(P>0.05)。针对N0期患者，LODDS分级系统对于预后的预测效能优于N分期和LNR分级(P<0.05)。 结论： N分期、LNR分级和LODDS分级均是影响R0切除胰腺癌患者预后的独立危险因素。而针对无淋巴结转移的患者，LODDS分级对于预后的预测优于N分期和LNR分级。.

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