阳性淋巴结对数比分期对Ⅲ期直肠癌患者预后的评估价值

The Prognostic Superiority of Log Odds of Positive Lymph Nodes in Patients with Stage Ⅲ Rectal Cancer

目的探讨阳性淋巴结对数比(LODDS)分期对Ⅲ期直肠癌患者术后3年无疾病生存(DFS)的评估价值。方法收集我院2010年1月至2014年12月就诊的Ⅲ期直肠癌根治术后患者的临床病理资料及随访数据,受试者工作特性(ROC)曲线计算LODDS的最佳截点值并分组,单因素和多因素分析患者的预后影响因素,ROC曲线下面积(AUC)比较pN分期、LODDS分期对3年DFS的预后评估能力。结果 LODDS分期最佳截点值为-0.3552,单因素分析结果显示:年龄(P=0.015)、癌结节(P=0.000)、神经侵犯/脉管癌栓(P=0.004)、术前CEA水平(P=0.012)、pN分期(P=0.000)和LODDS分期(P=0.001)均与本组患者3年DFS相关,不同分组间生存差异有统计学意义。多因素分析结果显示:pN分期(HR:2.258,95%CI:1.175-4.338,P=0.015)和LODDS分期(HR:2.638,95%CI:1.318-5.281,P=0.006)、癌结节(HR:1.860,95%CI:1.017-3.402,P=0.044)是本组患者3年DFS的独立预后因素。LODDS分期的AUC=0.730,pN分期的AUC=0.725,两者差异无统计学意义(P=0.857)。结论LODDS分期是Ⅲ期直肠癌患者术后3年无疾病生存的独立预后因素,对于预后评估具有重要意义。

Objective To assess the prognostic superiority of the log odds of positive lymph nodes（LODDS）in the patients with stageⅢ rectal cancer.Methods The clinical and pathological data and follow-up data of patients with stageⅢ rectal cancer who underwent radical surgery from January 2010 to December 2014 in our hospital were collected.The receiver operating characteristic（ROC）curve was used to calculate the optimal cut-off value of LODDS.Prognostic factors were analyzed by univariate and multivariate analysis.The relationship between the pN grade,LODDS,and 3-year disease free survival（DFS）rates were assessed.Results The optimal cut-off value of LODDS staging was-0.3552.Univariate analysis showed that age（P=0.015）,cancer nodules（P=0.000）,neurological invasion/vascular tumor thrombus（P=0.004）,preoperative CEA Levels（P=0.012）,pN stage（P=0.000）,and LODDS stage（P=0.001）were related to 3-year DFS.Multivariate analysis showed pN stage（HR：2.258,95% CI：1.175-4.338,P=0.015）,LODDS stage（HR：2.638,95% CI：1.318-5.281,P=0.006）,and cancer nodules（HR：1.860,95% CI：1.017-3.402,P=0.044）were independent prognostic factors for 3-year DFS.The AUC of the LODDS stage was 0.730,and the AUC of the pN stage was 0.725.There was no significant difference between the two（P=0.857）.ConclusionLODDS staging is an independent prognostic factor for 3-year disease-free survival in patients with stageⅢrectal cancer,and is of great significance for prognosis assessment.