基于淋巴结比率改良TNM分期预测模型在胃癌中的应用价值

Application study of a modified TNM stage prediction model based on the lymph node ratio in gastric cancer

目的评估基于淋巴结比率(LNR)所建立的新的rAJCC TNM分期预测模型(rAJCC分期系统)在临床中的应用价值。方法收集兰州大学第二医院诊断为非转移性胃癌并进行了D2淋巴结清扫术的患者数据,分别利用AJCC及rAJCC分期系统对患者进行分期并比较,评估rAJCC的rN分期与第八版AJCC分期的每个N分期对患者预后的影响。结果以LNR截点重新定义AJCC N分期,rN_(0)、rN_(1)、rN_(2)、rN_(3a)和rN_(3b)对应的5年OS率分别为71.9%、56.6%、52.3%、34.3%和33.1%(log-rank检验P<0.01),而rAJCC rN分期各期患者的5年OS率分别为84.6%(rⅠA期)、77.4%(rⅠB期)、43.8%(rⅡA期)、71.1%(rⅡB期)、37.4%(rⅢA期)、56.3%(rⅢB期)和27.4%(rⅢC期)(log-rank检验P<0.001),rAJCC分期系统的判别能力和预后同质性同比均优于第八版AJCC分期。结论基于LRN的新的rAJCC TNM分期预测模型在胃癌患者的分期及对患者的预后预测能力上具有一定优势,对胃癌患者的临床管理具有指导意义。

Objective Evaluate the application value in the clinical practice of the new rAJCC TNM prediction model(rAJCC staging system).Method Collect the data from the patients diagnosed with nonmetastatic gastric cancer in the Second Hospital of Lanzhou University after D2 lymph node dissection.Patients were staged and compared by the AJCC and rAJCC staging systems respectively.Assess the prognostic impact of each N stage in the new rAJCC stage and the eighth edition AJCC.Result According to the LNR cut-off point,the rAJCC staging rate was 71.9%,56.6%,52.3%,34.3%,and 33.1%(log),and the corresponding 5-year OS rates of rN_(0),rN_(1),rN_(2),rN_(3a),and rN_(3b) were 71.9%,56.6%,52.3%,34.3%,and 33.1%,respectively.-rank test P<0.01).Based on rN staging,the 5-year OS rates of patients in each stage of rAJCC are 84.6%(rⅠA stage),77.4%(rⅠB stage),43.8%(rⅡA stage),71.1%(rⅡB stage),37.4%(rⅢA stage),56.3%(rⅢB stage)and 27.4%(rⅢC stage)(log-rank test P<0.001).The distinguishing ability and prognostic homogeneity of rAJCC staging are better than those of the eighth edition of AJCC staging.Conclusion The rAJCC TNM prediction model based on LNR performs well in the prognosis prediction and evaluation of gastric cancer patients and is instructive for the clinical management of gastric cancer patients.