阳性淋巴结对数比(LODDS)对食管鳞癌左胸入路根治术后pN_(0)期患者预后的预测价值

The predictive value of log odd of positive lymph nodes in the prognosis of patients with pN_(0) stage esophageal squamous cell carcinoma after left thoracic approach radical resection

目的:探讨阳性淋巴结对数比(LODDS)对食管鳞癌左胸入路根治术后pN_(0)期患者预后的预测价值。方法:回顾性分析2005年01月至2014年12月期间在我院胸外科行左胸入路的食管癌根治术,且术后病理类型为鳞癌,病理分期为N_(0)期的336例患者的临床、病理及随访资料,分析LODDS对该组患者预后的影响及其判断预后的最佳截点值,应用SPSS 19.0软件进行统计学分析。结果:ROC曲线分析显示,当LODDS以-1.278为最佳截点值时,其约登指数最大,预测患者预后效果最好。将全组患者的LODDS值以-1.278分为≤-1.278组和>-1.278组,两组患者1、3、5年生存率分别为92.3%、82.1%、75.0%和86.1%、62.6%、52.6%,差异有显著性(χ^(2)=19.241,P=0.000)。全组患者1、3、5年生存率分别为89.5%、71.7%和63.0%。COX多因素分析结果显示,患者年龄、pT分期和LODDS为影响其生存的独立性因素。结论:本研究结果显示,LODDS为胸段食管鳞癌左胸入路根治术后pN_(0)期患者预后的独立性影响因素,且LODDS≤-1.278的患者具有较好的预后。本研究结果尚需多中心、大样本的临床研究进一步证实。

Objective:To investigate the predictive value of log odd of positive lymph nodes(LODDS)in the prognosis of patients with pN_(0) esophageal squamous cell carcinoma(ESCC)after left thoracic approach radical resection.Methods:A retrospective analysis of the clinical pathology and follow-up data of 336 patients with pN_(0) stage ESCC who underwent radical resection of esophageal cancer in our hospital from January 2005 to December 2014.The effect of LODDS on the prognosis of this group and its optimal cut-off value were analyzed.SPSS 19.0 software was used for statistical analysis.Results:ROC curve analysis showed that when LODDS was the best cutoff point of-1.278,its approximate index was the largest.The LODDS values of the whole group were divided into≤-1.278 group and>-1.278 group by-1.278.The 1-,3-,and 5-year survival rates of the two groups were 92.3%,82.1%,75.0%and 86.1%,62.6%,52.6%,respectively,the difference was significant(χ^(2)=19.241,P=0.000).The 1-,3-,and 5-year survival rates of the whole group were 89.5%,71.7%and 63.0%,respectively.COX multivariate analysis showed that patient age,pT stage and LODDS were independent factors influencing their survival.Conclusion:The results of this study show that LODDS is an independent prognostic factor for patients with pN_(0) thoracic esophageal squamous cell carcinoma after left thoracic approach radical resection,patients with LODDS≤-1.278 have a good prognosis.The results of this study need to be multi-centered,a large sample of clinical studies is further confirmed.