淋巴结阳性比率对评估肺腺癌患者预后的价值研究

Value of lymph node positive ratio in evaluating the prognosis of patients with lung adenocarcinoma

目的 探究阳性淋巴结比率对评估肺腺癌患者预后的价值,并探讨包含阳性淋巴结比率的预测模型对肺腺癌患者总体生存率的预测价值。方法 选取2010-2016年SEER数据库中符合纳入与排除标准的36 335例肺腺癌患者为研究对象,并根据7∶3的比例随机分配这些肺腺癌患者至SEER训练集和SEER验证集,利用X-tile软件确定阳性淋巴结比率的最佳截断点。利用LASSO Cox回归选取独立影响肺腺癌患者预后的因子,并构建预测模型。此外,纳入90例该院的肺腺癌患者作为外部验证集。结果 SEER训练集中有75.1%的患者无淋巴结转移,SEER验证集中有75.0%的患者未发生淋巴结转移,外部验证集中有44.4%的患者未发生淋巴结转移。X-tile结果表明当阳性淋巴结比率为0.2时,3组肺腺癌患者之间的生存差异性最大。LASSO Cox回归分析表明阳性淋巴结比率、性别、年龄、肿瘤分级、肿瘤大小、M分期和TNM分期均是肺腺癌患者预后的独立影响因子。包含阳性淋巴结比率的列线图对SEER训练集(3年总体生存率的AUC为0.714,5年总体生存率的AUC为0.700,10年总体生存率的AUC为0.718)、SEER验证集(3年总体生存率的AUC为0.710,5年总体生存率的AUC为0.709,10年总体生存率的AUC为0.704)和外部验证集(3年总体生存率的AUC为0.703,5年总体生存率的AUC为0.798,10年总体生存率的AUC为0.769)肺腺癌患者总体生存率的预测价值较高。结论 阳性淋巴结比率充分考虑了淋巴结转移的数目和清扫淋巴结总数对肺腺癌患者预后的影响,具有较高的预后价值。阳性淋巴结比率>0.2是肺腺癌患者总体生存期差的独立危险因素,包含阳性淋巴结比率的列线图对肺腺癌患者预后预测价值很高。

Objective To explore the prognostic value of positive lymph node ratio in patients with lung adenocarcinoma,and to investigate the predictive value of the predictive model including positive lymph node ratio on the overall survival rate of patients with lung adenocarcinoma.Methods A total of 36335 patients with lung adenocarcinoma in the SEER database from 2010 to 2016 were selected and randomly assigned to the training set and SEER verification set according to the ratio of 7∶3.X-tile software was used to determine the best cut-off point of positive lymph node ratio.The independent prognostic factors were selected by LASSO Cox regression,and a predicting model was constructed.In addition,a total of 90 patients with lung adenocarcinoma from Hubei Provincial Hospital of Integrated Chinese and Western Medicine were included as the external validation set.Results No lymph node metastasis was found in 75.1%of the patients in the SEER training set,75.0%in the SEER validation set and 44.4%in the external validation.X-tile results showed the greatest survival difference among the three groups when the positive lymph node ratio was 0.2.LASSO Cox regression analysis revealed that positive lymph node ratio,gender,age,tumor grade,tumor size,M stage and TNM stage were independent prognostic factors of lung adenocarcinoma.The nomogram containing positive lymph node ratios had a high predictive value for the overall survival rate of patients with lung adenocarcinoma in the SEER training set(AUC of three-year survival rate:0.714;AUC of five-year survival rate:0.700;AUC of ten-year survival rate:0.718),SEER validation set(AUC of three-year survival rate:0.710;AUC of five-year survival rate:0.709;AUC of ten-year survival rate:0.704),and external validation set(AUC of three-year survival rate:0.703;AUC of five-year survival rate:0.798;AUC of ten-year survival rate:0.769).Conclusion The positive lymph node ratio fully considers the number of lymph node metastasis and the total number of lymph node dissections on the survival of patients with lung adenocarcinoma,which exhibited good prognostic value.The positive lymph node ratio greater than 0.2 is an independent risk factor for poor overall survival of patients with lung adenocarcinoma.The nomogram containing a positive lymph node ratio has a high predictive value for the prognosis of patients with lung adenocarcinoma.