阳性淋巴结对数比(LODDS)对食管鳞癌左胸入路根治术后pN0期患者预后的预测价值

Prognostic Value of Logarithm Ratio of Positive Lymph Nodes(LODDS)on Patients in Stage pN0 After Left Thoracic Approach Radical Resection of Esophageal Squamous Cell Carcinoma

目的探讨阳性淋巴结对数比(LODDS)在预测食管鳞癌左胸入路根治术后pN0期患者预后中的临床价值。方法回顾性分析80例食管鳞癌患者临床资料。所有患者均行左胸入路食管癌根治术+淋巴结清扫术治疗,送检标本计算LODDS;绘制ROC曲线分析LODDS在预测食管鳞癌术后pN0期患者预后的临床价值,并依据LODDS最佳截点值分组,统计患者预后生存情况;收集所有患者年龄、性别、体质量指数、病变位置、分化程度、肿瘤分期、肿瘤直径、LODDS等多方面资料,采用COX回归分析获得食管鳞癌术后pN0期患者预后的独立危险因素。结果全组患者LODDS中位数为-1.35(-2.02~0.53),当LODDS处于-1.23时约登指数(1.212)最大,以-1.23为最佳截点预测患者预后的灵敏度为0.785,特异度为0.512,曲线下面积(AUC)为0.627(P=0.045);80例患者随访3年,存活率为81.25%(65/80);依据-1.23分为>-1.23组(42例)与≤-1.23组(38例),其中≤-1.23组存活率为92.11%(35/38),高于>-1.23组的71.43%(30/42),差异有统计学意义(χ^(2)=5.599,P=0.018);单因素分析显示,不同肿瘤直径、分化程度、肿瘤浸润深度、LODDS患者间3年存活率相比,差异有统计学意义(P<0.05);多因素分析显示,肿瘤直径、分化程度、肿瘤浸润深度及LODDS为影响食管鳞癌术后pN0期患者预后的独立危险因素(P<0.05)。结论LODDS在食管鳞癌术后pN0期患者预后预测中具有一定价值,LODDS为影响患者预后的独立因素,LODDS>-1.23时患者生存率明显下降,临床可据此制定术后治疗方案,以更好的改善患者预后。

Objective To investigate the prognostic value of logarithm ratio of positive lymph nodes(LODDS)on patients in stage pN0 after left thoracic approach radical resection of esophageal squamous cell carcinoma.Methods Clinical data of 80 patients with esophageal squamous cell carcinoma treated were retrospectively analyzed.All patients were treated with radical esophagectomy via left thoracic approach+lymph node dissection,and LODDS was calculated for the submitted samples;ROC curve analysis of LODDS in predicting postoperative prognosis of patients in stage pN0 of esophageal squamous cell carcinoma,and the prognosis and survival of patients were counted according to the best cut-off point value of LODDS;The age,sex,body mass index,lesion location,degree of differentiation,tumor stage,tumor diameter,LODDS and other data of all patients were collected.The independent risk factors for prognosis of patients in stage pN0 esophageal squamous cell carcinoma was obtained by Cox regression analysis.Results The median LODDS of all patients was-1.35(-2.02~0.53).When LODDS was-1.23,the yoden index(1.212)was the largest.The sensitivity and specificity of-1.23 as the best cut-off point for predicting the prognosis of patients were 0.785,0.512,and the area under the curve(AUC)was 0.627(P=0.045);80 patients were followed up for 3 years.The survival rate was 81.25%(65/80);According to-1.23,the patients were divided into>-1.23 group(42 cases)and≤-1.23 group(38 cases).The survival rate of≤-1.23 group was 92.11%(35/38),which was higher than that of>-1.23 group(71.43%(30/42).The difference was statistically significant(χ^(2)=5.599,P=0.018);Univariate analysis showed that there were significant differences in the 3-year survival rate among patients with different tumor diameter,depth of tumor invasion and LODDS;Multivariate analysis showed that tumor diameter,degree of differentiation,depth of tumor invasion and LODDSwere the main independent risk factors affecting prognosis of patients in stage pN0 of esophageal squamous cell carcinoma(P<0.05).Conclusion LODDS has a positive effect in predicting the prognosis of patients in stage pN0 esophageal squamous cell carcinoma.LODDS is an independent factor affecting the prognosis of patients.When LODDS>-1.23,the survival rate of patients is significantly lower.Therefore,the clinical treatment plan can be formulated to better improve the prognosis of patients.