淋巴结阳性率对ⅢC期子宫内膜癌的预后意义

Prognostic Value of Positive Lymph Node Ratio on StageⅢC Uterine Endometrial Cancer

目的评估淋巴结阳性率(LNR)对ⅢC期子宫内膜癌的预后价值。方法选取SEER数据库ⅢC期子宫内膜癌患者3840例,TCGA数据库ⅢC期子宫内膜癌患者79例,应用X-tile软件选择LNR的最佳截断点,运用单因素和多因素COX回归分析LNR在ⅢC期子宫内膜癌患者预后预测价值,ROC曲线用于预后评估准确性比较。结果X-tile软件筛选出LNR的最佳截断点为LNR<0.31和LNR≥0.31。单因素和多因素COX回归分析结果显示,LNR、年龄、种族、分化程度、病理类型是影响ⅢC期子宫内膜癌总体生存时间(OS)及肿瘤特异生存时间(CSS)的独立危险因素,LNR<0.31组患者的预后明显优于LNR≥0.31组(Log-rank P<0.01)。LNR(LNR<0.31,LNR≥0.31)与ⅢC分期(ⅢC1与ⅢC2期)评估预后的ROC曲线显示,LNR评估OS与CSS的价值明显优于FIGO分期(Pos=1.86e-6,Pcss=2.9e-4)。结论LNR≥0.31是ⅢC期子宫内膜癌独立的预后风险因素,且LNR预后评估价值优于FIGOⅢC分期。

Objective To investigate the value of positive lymph node ratio(LNR)in predicting the prognosis of patients with stageⅢC uterine endometrial cancer.Methods We retrieved clinical data of 3840 patients with stageⅢC uterine endometrial cancer from SEER database and 79 patients with stageⅢC uterine endometrial cancer from TCGA database.The best cutoff point of LNR was selected using X-tile software.Univariate and multivariate COX regression analysis were used to assess the value of LNR in prognosis prediction.ROC curves were used to compare the accuracy on prognosis prediction.Results The best cut-off point of LNR determined by X-tile 3.6.1 software was 0.31.Univariate and multivariate COX regression analysis proved that age,race,grade,pathological type and LNR were independent prognostic factors for overall survival and cancer-specific survival.And the prognosis of patients with LNR<0.31 was better than that of patients with LNR≥0.31(Log-rank P<0.01).ROC curves showed that LNR(LNR<0.31,LNR≥0.31)was better than FIGOⅢC sub-staging in predicting OS and CSS(Pos=1.86 e-6,Pcss=2.9 e-4).Conclusion LNR≥0.31 is an independent prognostic factor for patients with stageⅢC uterine endometrial cancer,and its prognostic value is higher than FIGOⅢC sub-staging.