Predictive value of positive lymph node ratio in patients with locally advanced gastric remnant cancer

BACKGROUND Traditional lymph node stage(N stage)has limitations in advanced gastric remnant cancer(GRC)patients;therefore,establishing a new predictive stage is necessary.AIM To explore the predictive value of positive lymph node ratio(LNR)according to clinicopathological characteristics and prognosis of locally advanced GRC.METHODS Seventy-four patients who underwent radical gastrectomy and lymphadenectomy for locally advanced GRC were retrospectively reviewed.The relationship between LNR and clinicopathological characteristics was analyzed.The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model.RESULTS Number of metastatic LNs,tumor diameter,depth of tumor invasion,Borrmann type,serum tumor biomarkers,and tumor-node-metastasis(TNM)stage were correlated with LNR stage and N stage.Univariate analysis revealed that the factors affecting survival included tumor diameter,anemia,serum tumor biomarkers,vascular or neural invasion,combined resection,LNR stage,N stage,and TNM stage(all P<0.05).The median survival time for those with LNR0,LNR1,LNR2 and LNR3 stage were 61,31,23 and 17 mo,respectively,and the differences were significant(P=0.000).Anemia,tumor biomarkers and LNR stage were independent prognostic factors for survival in multivariable analysis(all P<0.05).CONCLUSION The new LNR stage is uniquely based on number of metastatic LNs,with significant prognostic value for locally advanced GRC,and could better differentiate overall survival,compared with N stage.

Advantage of log odds of positive lymph nodes in prognostic evaluation of patients with early-onset colon cancer

BACKGROUND Colon cancer(CC)is one of the most common cancers of the digestive tract,the third most common cancer worldwide,and the second most common cause of cancer-related deaths.Previous studies have demonstrated a higher risk of lymph node metastasis(LNM)in young patients with CC.It might be reasonable to treat patients with early-onset locally advanced CC with extended lymph node dissection.However,few studies have focused on early-onset CC(ECC)patients with LNM.At present,the methods of predicting and evaluating the prognosis of ECC patients with LNM are controversial.From the data of patients with CC obtained from the Surveillance,Epidemiology,and End Results(SEER)database,data of young patients with ECC(≤50 years old)was screened.Patients with unknown data were excluded from the study,while the remaining patients were included.The patients were randomly divided into a training group(train)and a testing group(test)in the ratio of 7:3,while building the model.The model was constructed by the training group and verified by the testing group.Using multiple Cox regression models to compare the prediction efficiency of LNM indicators,nomograms were built based on the best model selected for overall survival(OS)and cause-specific survival(CSS).In the two groups,the performance of the nomogram was evaluated by constructing a calibration plot,time-dependent area under the curve(AUC),and decision curve analysis.Finally,the patients were grouped based on the risk score predicted by the prognosis model,and the survival curve was constructed after comparing the survival status of the high and low-risk groups.RESULTS Records of 26922 ECC patients were screened from the SEER database.N classification,positive lymph nodes(PLN),lymph node ratio(LNR)and log odds of PLN(LODDS)were considered to be independent predictors of OS and CSS.In addition,independent risk factors for OS included gender,race,marital status,primary site,histology,grade,T,and M classification,while the independent prognostic factors for CSS included race,marital status,primary site,grade,T,and M classification.The prediction model including LODDS is composed of minimal Akaike information criterion,maximal concordance indexes,and AUCs.Factors including gender,race,marital status,primary site,histology,grade,T,M classification,and LODDS were integrated into the OS nomogram,while race,marital status,primary site,grade,T,M classification,and LODDS were included into the CSS nomogram.The nomogram representing both cohorts had been successfully verified in terms of prediction accuracy and clinical practicability.CONCLUSION LODDS is superior to N-stage,PLN,and LNR of ECC.The nomogram containing LODDS might be helpful in tumor evaluation and clinical decision-making,since it provides an appropriate prediction of ECC.

Effect of the number of positive lymph nodes and lymph node ratio on prognosis of patients after resection of pancreatic adenocarcinoma

BACKGROUND： The prognostic factors related to lymph node involvement [lymph node status, the number of positive lymph nodes, lymph node ratio （LNR）] and the number of nodes evaluated in patients with pancreatic adenocarcinoma after pancreatectomy are poorly defined. METHODS： A total of 167 patients who had undergone resection of pancreatic adenocarcinoma from February 2010 to August 2011 were included in this study. Histological examination was performed to evaluate the tumor differentiation and lymph node involvement. Univariate and multivariate analyses were made to determine the relationship between the variables related to nodal involvement and the number of nodes and survival. RESULTS： The median number of total nodes examined was 10 （range 0-44） for the entire cohort. The median number of total nodes examined in node-negative （pN0） patients was similar to that in node-positive （pN1） patients. Patients with pN1 diseases had significantly worse survival than those with pN0 ones （P=0.000）. Patients with three or more positive nodes had a poorer prognosis compared with those with the negative nodes （P=0.000）. The prognosis of the patients with negative nodes was similar to that of those with one to two positive nodes （P=0.114）. The median survival of patients with an LNR ≥0.4 was shorter than that of patients with an LNR 〈0.4 in the pN1 cohort （P=0.014）. No significance was found between the number of total nodes examined and the prognosis, regardless of the cutoff of 10 or 12 and in the entire cohort or the pN0 and pN1 groups. Based on the multivariate analysis of the entire cohort and the pN1 group, the nodal status, the number of positive nodes and the LNR were all associated with survival. CONCLUSIONS： In addition to the nodal status, the number of positive nodes and the LNR can serve as comprehensive factors for the evaluation of nodal involvement. This approach may be more effective for predicting the survival of patients with pancreatic adenocarcinoma after pancreatectomy.

Development and validation of prognostic nomogram based on log odds of positive lymph nodes for patients with gastric signet ring cell carcinoma

Objective: Our aims were to establish novel nomogram models, which directly targeted patients with signet ring cell carcinoma(SRC), for individualized prediction of overall survival(OS) rate and cancer-specific survival(CSS).Methods: We selected 1,365 SRC patients diagnosed from 2010 to 2015 from Surveillance, Epidemiology and End Results(SEER) database, and then randomly partitioned them into a training cohort and a validation cohort.Independent predicted indicators, which were identified by using univariate testing and multivariate analyses, were used to construct our prognostic nomogram models. Three methods, Harrell concordance index(C-index), receiver operating characteristics(ROC) curve and calibration curve, were used to assess the ability of discrimination and predictive accuracy. Integrated discrimination improvement(IDI), net reclassification improvement(NRI) and decision curve analysis(DCA) were used to assess clinical utility of our nomogram models.Results: Six independent predicted indicators, age, race, log odds of positive lymph nodes(LODDS), T stage, M stage and tumor size, were associated with OS rate. Nevertheless, only five independent predicted indicators were associated with CSS except race. The developed nomograms based on those independent predicted factors showed reliable discrimination. C-index of our nomogram for OS and CSS was 0.760 and 0.763, which were higher than American Joint Committee on Cancer(AJCC) 8 th edition tumor-node-metastasis(TNM) staging system(0.734 and 0.741, respectively). C-index of validation cohort for OS was 0.757 and for CSS was 0.773. The calibration curves also performed good consistency. IDI, NRI and DCA showed the nomograms for both OS and CSS had a comparable clinical utility than the TNM staging system.Conclusions: The novel nomogram models based on LODDS provided satisfying predictive ability of SRC both in OS and CSS than AJCC 8 th edition TNM staging system alone.

Log odds of positive lymph nodes is a better prognostic factor for oesophageal signet ring cell carcinoma than N stage

BACKGROUND Signet ring cell carcinoma is a rare type of oesophageal cancer,and we hypothesized that log odds of positive lymph nodes(LODDS)is a better prognostic factor for oesophageal signet ring cell carcinoma.AIM To explore a novel prognostic factor for oesophageal signet ring cell carcinoma by comparing two lymph node-related prognostic factors,log odds of positive LODDS and N stage.METHODS A total of 259 cases of oesophageal signet ring cell carcinoma after oesophagectomy were obtained from the Surveillance,Epidemiology,and End Results database between 2006 and 2016.The prognostic value of LODDS and N stage for oesophageal signet ring cell carcinoma was evaluated by univariate and multivariate analyses.The Akaike information criterion and Harrell’s C-index were used to assess the value of two prediction models based on lymph nodes.External validation was performed to further confirm the conclusion.RESULTS The 5-year cancer-specific survival(CSS)and 5-year overall survival(OS)rates of all the cases were 41.3%and 27.0%,respectively.The Kaplan-Meier method showed that LODDS had a higher score of log rank chi-squared(OS:46.162,CSS:41.178)than N stage(OS:36.215,CSS:31.583).Univariate analyses showed that insurance,race,T stage,M stage,TNM stage,radiation therapy,N stage,and LODDS were potential prognostic factors for OS(P<0.1).The multivariate Cox regression model showed that LODDS was an significant independent prognostic factor for oesophageal signet ring carcinoma patients after surgical resection(P<0.05),while N stage was not considered to be a significant prognostic factor(P=0.122).Model 2(LODDS)had a higher degree of discrimination and fit than Model 1(N stage)(LODDS vs N stage,Harell’s C-index 0.673 vs 0.656,P<0.001;Akaike information criterion 1688.824 vs 1697.519,P<0.001).The results of external validation were consistent with those in the study cohort.CONCLUSION LODDS is a superior prognostic factor to N stage for patients with oesophageal signet ring cell carcinoma after oesophagectomy.

Different lymph node staging systems for predicting the prognosis of colorectal neuroendocrine neoplasms

BACKGROUND Colorectal neuroendocrine neoplasms(NENs)are a rare malignancy that primarily arises from the diffuse distribution of neuroendocrine cells in the colon and rectum.Previous studies have pointed out that the status of lymph node may be used to predict the prognosis.AIM To investigate the predictive values of lymph node ratio(LNR),positive lymph node(PLN),and log odds of PLNs(LODDS)staging systems on the prognosis of colorectal NENs treated surgically,and compare their predictive values.METHODS This cohort study included 895 patients with colorectal NENs treated surgically from the Surveillance,Epidemiology,and End Results database.The endpoint was mortality of patients with colorectal NENs treated surgically.X-tile software was utilized to identify most suitable thresholds for categorizing the LNR,PLN,and LODDS.Participants were selected in a random manner to form training and testing sets.The prognosis of surgically treating colorectal NENs was examined using multivariate cox analysis to assess the associations of LNR,PLN,and LODDS with the prognosis of colorectal NENs.C-index was used for assessing the predictive effectiveness.We conducted a subgroup analysis to explore the different lymph node staging systems’predictive values.RESULTS After adjusting all confounding factors,PLN,LNR and LODDS staging systems were linked with mortality in patients with colorectal NENs treated surgically(P<0.05).We found that LODDS staging had a higher prognostic value for patients with colorectal NENs treated surgically than PLN and LNR staging systems.Similar results were obtained in the different G staging subgroup analyses.Furthermore,the area under the receiver operating characteristic curve values for LODDS staging system remained consistently higher than those of PLN or LNR,even at the 1-,2-,3-,4-,5-and 6-year follow-up periods.CONCLUSION LNR,PLN,and LODDS were found to significantly predict the prognosis of patients with colorectal NENs treated surgically.

Prognostic importance of lymph node yield after curative resection of gastroenteropancreatic neuroendocrine tumours

BACKGROUND The prognostic significance of lymph nodes(LNs)metastases and the optimum number of LN yield in gastroenteropancreatic neuroendocrine tumours(GEP NETs)undergoing curative resection is still debatable.Many studies have demonstrated that cure rate for patients with GEP NETs can be improved by the resection of the primary tumour and regional lymphadenectomy AIM To evaluate the effect of lymph node(LN)status and yield on relapse-free survival(RFS)and overall survival(OS)in patients with resected GEP NETs.METHODS Data on patients who underwent curative resection for GEP NETs between January 2002 and March 2017 were analysed retrospectively.Grade 3 tumours(Ki67>20%)were excluded.Univariate Cox proportional hazard models were computed for RFS and OS and assessed alongside cut-point analysis to distinguish a suitable binary categorisation of total LNs retrieved associated with RFS.RESULTS A total of 217 patients were included in the study.The median age was 59 years(21-97 years)and 51%(n=111)were male.Primary tumour sites were small bowel(42%),pancreas(25%),appendix(18%),rectum(7%),colon(3%),gastric(2%),others(2%).Median follow up times for all patients were 41 mo(95%CI:36-51)and 71 mo(95%CI:63–76)for RFS and OS respectively;50 relapses and 35 deaths were reported.LNs were retrieved in 151 patients.Eight or more LNs were harvested in 106 patients and LN positivity reported in 114 patients.Three or more positive LNs were detected in 62 cases.The result of univariate analysis suggested perineural invasion(P=0.0023),LN positivity(P=0.033),LN retrieval of≥8(P=0.047)and localisation(P=0.0049)have a statistically significant association with shorter RFS,but there was no effect of LN ratio on RFS:P=0.1 or OS:P=0.75.Tumour necrosis(P=0.021)and perineural invasion(P=0.016)were the only two variables significantly associated with worse OS.In the final multivariable analysis,localisation(pancreas HR=27.33,P=0.006,small bowel HR=32.44,P=0.005),and retrieval of≥8 LNs(HR=2.7,P=0.036)were independent prognostic factors for worse RFS.CONCLUSION An outcome-oriented approach to cut-point analysis can suggest a minimum number of adequate LNs to be harvested in patients with GEP NETs undergoing curative surgery.Removal of≥8 LNs is associated with increased risk of relapse,which could be due to high rates of LN positivity at the time of surgery.Given that localisation had a significant association with RFS,a prospective multicentre study is warranted with a clear direction on recommended surgical practice and follow-up guidance for GEP NETs.

食管癌根治术后患者预后模型的构建与验证:一项基于SEER数据库的研究

目的构建并验证能准确预测食管癌(EC)根治术后患者预后的列线图模型。方法从美国国立癌症研究所监测、流行病学和结局(SEER)数据库中提取1754例符合条件的EC患者。使用LASSO回归和Cox回归分析确定患者生存的独立危险因素,并根据多因素Cox回归分析的结果构建列线图。通过一致性指数(C-index)、校准曲线、受试者工作特征(ROC)曲线和临床决策曲线分析(DCA)评估列线图的预测性能。结果年龄、分化等级、T分期、肿块大小和阳性淋巴结对数比(LODDS)是EC根治术后患者总生存期(OS)的独立预测因素(P<0.05),并基于上述变量构建列线图。C-index、校准曲线和ROC曲线结果显示模型相对于TNM分期有着更好的辨别能力,DCA曲线显示列线图可以使患者有较好的临床获益。结论本研究构建的列线图相较于传统TNM分期有着更准确的预测能力,能够为患者带来更多的临床获益。

晚期卵巢癌患者进行满意肿瘤细胞减灭术后盆腹腔淋巴结转移与患者预后分析

目的本研究旨在对晚期卵巢癌患者进行满意肿瘤细胞减灭术后对淋巴结(LN)转移与患者预后进行分析。方法回顾性分析了120例行满意肿瘤细胞减灭术的晚期卵巢癌患者,通过对比分析术后患者的淋巴结状态、转移性淋巴结数量(MLN)、淋巴结转移率(LNR)和阳性淋巴结对数比(LODDS),使用Kaplan-Meier单变量分析和多变量Cox回归分析患者总体生存率,预测术后独立预后因素。根据受试者工作特征(ROC)曲线,比较不同淋巴结指标对晚期卵巢癌患术后生存的预测能力。结果120例晚期患者中淋巴结阴性有71例(59.20%),淋巴结阳性有49例(40.80%),多变量分析结果显示,阳性LN状态、MLN、LNR和LODDS是影响总生存期(OS)独立危险因素。与淋巴结状态、转移性淋巴结数量相比,在预测1年、3年和5年OS时,AUC最高的变量是LODDS(P<0.05)。结论本研究表明阳性LN状态、MLN、LNR和LODDS是预测卵巢癌患者OS的指标。其中,LODDS是预测卵巢癌患者行满意肿瘤细胞减灭术后死亡率的最佳预后预测因子。

基于淋巴结阳性率的胃印戒细胞癌预后模型的建立与验证

目的探讨淋巴结阳性率(LNR)在胃印戒细胞癌(GSRCC)预后中的价值,并构建基于LNR的预后列线图进行验证。方法收集并整理了SEER数据库和江苏大学附属宜兴医院GSRCC患者数据,分别作为训练集和验证集。利用Kaplan-Meier法绘制生存曲线,通过单因素和多因素Cox模型进行预后分析。构建基于LNR的预后列线图,并在验证集中进行验证。结果与低LNR患者相比,高LNR患者肿瘤分期更晚,中LNR患者化疗比例更高(P<0.05)。训练集低、中、高LNR患者的5年癌症特异性生存率分别为71.1%、30.7%、8.9%,差异有统计学意义(P<0.05)。验证集低、中、高LNR患者的5年癌症特异性生存率为85.0%、53.2%、17.9%,差异有统计学意义(P<0.05)。多因素回归分析显示,年龄、肿瘤大小、T分期、LNR、Stage分期、化疗是影响GSRCC预后的独立预后因素。进一步构建列线图模型,该模型在内部抽取和外部验证方面都具有较好的预测一致性。在内部验证中,1、3、5年生存率的曲线下面积(AUC)分别为0.787、0.848、0.855,外部验证的AUC分别为0.724、0.729、0.737。结论LNR对GSRCC具有独立的预后价值,以LNR为基础的列线图模型可被视为GSRCC预后的重要预测指标。

探索阳性淋巴结比率在ypⅢ期结直肠癌患者中的预后价值及预测模型的建立

背景与目的:当前,对于中低位局部晚期直肠癌和T4bM0的潜在可切除结肠癌患者,指南均推荐新辅助治疗策略,以提高治疗的缓解率和增加转化性切除的可能性。其中对于ypⅢ期的结直肠癌(colorectal cancer,CRC)患者,均使用国际抗癌联盟(Union for International Cancer Control,UICC)/美国癌症联合会(American Joint Committee on Cancer,AJCC)TNM分期系统评估术后病理学特征。然而,新辅助治疗会导致术区淋巴结退缩,检出淋巴结数不足12枚的患者无法按照常规的TNM分期进行划分,因此TNM分期常无法预测接受过新辅助治疗的ypⅢ期患者的预后。本研究旨在评估阳性淋巴结比率(positive lymph node ratio,LNR)在接受新辅助治疗的ypⅢ期CRC患者中的预后价值。方法:回顾性分析2008—2018年在复旦大学附属肿瘤医院接受新辅助治疗且行根治性手术的ypⅢ期CRC患者。收集患者手术时的年龄、性别、原发肿瘤位置、肿瘤分化等级、病理学分期以及随访期间患者是否复发或死亡等临床病理学特征。纳入标准:接受新辅助治疗和手术且术后病理学检查证实为Ⅲ期的CRC患者。排除标准:①术前影像学检查或术中探查发现已有远处脏器转移;②有既往恶性肿瘤病史;③多原发性CRC。本研究通过复旦大学附属肿瘤医院医学伦理委员会批准(伦理编号:050432-4-2108*)。使用R软件的survminer包(surv_cutpoint算法)计算LNR相对于无病生存期(disease-free survival,DFS)的最佳临界值并依此将患者分为低LNR组和高LNR组,比较两组的临床病理学特征和DFS。采用COX比例风险回归模型筛选不良病理学特征并使用survival包和rms包绘制DFS列线图预测模型。结果:共纳入489例患者,男性289例,女性200例,中位年龄为56岁(23~80岁),中位随访时间为1062 d。随访期间,164例(33.5%)患者死亡。整个队列中,204例(41.7%)患者检出淋巴结数不足12枚。LNR的最佳临界值为0.29,317例患者划为低LNR组(LNR≤0.29),172例患者划为高LNR组(LNR>0.29)。高LNR组相比低LNR组DFS更短[风险比(hazard ratio,HR)=2.103,95%CI:1.582~2.796,P<0.0001]。多变量COX回归分析显示,LNR是DFS的独立预后危险因素(HR=1.825,95%CI:1.391~2.394,P<0.001)。根据纳入LNR的多分类DFS列线图预测模型可以有效地评估接受新辅助治疗的Ⅲ期CRC患者的DFS。结论:LNR是ypⅢ期CRC患者的独立预后因素,与其他不良临床病理学特征联合使用具有良好的DFS预测效力。因此,将LNR作为TNM分期的补充可以提高CRC的预后评估准确率。

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

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。

食管癌根治患者LODDS变化及3年预后状况评估

目的 对食管癌根治患者阳性淋巴结对数比(LODDS)变化及3年预后状况评估及分析。方法 选取2015年1月至2020年1月在本院进行食管癌根治术的102例食管癌患者进行研究。患者进行食管癌根治术治疗后,进行3年以上的随访,根据患者3年以上的随访情况,利用受试者应用曲线(ROC)评估患者LODDS分期标准,将患者按照LODDS分期标准进行分组,用极限乘积法(Kaplan-Meier)对比患者LODDS分组后预后3年的生存分析,并利用对数秩检验法(Log-rank)比较组间生存率。同时,采用单因素logistic回归及Cox多因素分析法分析影响患者预后3年无疾病生存(DFS)的因素,并利用ROC曲线评估LODDS分期及淋巴结病理分类(PN)分期对患者3年预后DFS评价能力。结果 经ROC曲线分析,患者的LODDS分期的最佳截点值为-1.15,即在ROC曲线最佳截点值-1.15时患者的LODDS分期的约登指数最大,此时对患者生存影响的敏感度为74.3%,特异度为58.2%,曲线下面积为0.700,将患者按照LODDS分为LODDS≤-1.15组,LODDS>-1.15组;经预后3年的生存曲线分析,LODDS<-1.15组患者的生存期明显大于LODDS≥-1.15组,差异有统计学意义(P<0.05);经单因素logistic回归分析结果显示,年龄、性别、分化程度、手术清扫淋巴结个数、是否神经侵犯、病理类型、T分期、PN分期、LODDS分期与患者3年预后DFS相关,差异有统计学意义(P<0.05);经Cox分析结果显示,年龄、性别、分化程度、手术清扫淋巴结个数、是否神经侵犯、病理类型、T分期、PN分期、LODDS分期均是影响患者3年预后DFS的独立因素,(P<0.001);经ROC曲线对比分析,患者LODDS分期曲线下面积为0.700明显大于患者PN分期曲线下面积0.645,LODDS分期对患者3年预后DFS评价能力明显高于PN分期,差异有统计学意义(P<0.001)。结论 LODDS变化对食管癌根治患者3年预后状况评估及分析具有一定的意义,是评估患者3年预后DFS的独立因素,值得推广应用。

淋巴结转移数和淋巴结转移率与乳腺癌预后关系的分析比较

目的:探讨淋巴结转移率(lymph node ratio,LNR)是否能更优于淋巴结转移数(positive lymph nodes,PLN),用于评价乳腺癌术后患者的复发风险和总生存时间。方法:回顾性分析1089例淋巴结清扫数目为10枚或以上、术后经病理证实淋巴结转移阳性的原发性浸润性乳腺癌患者临床病理资料。结果:单因素生存分析,肿瘤大小分期,组织学分级、ER/PR/HER-2状态、PLN、LNR、切检淋巴结总数、结外软组织侵犯、辅助治疗与患者RFS(relapse free survival,RFS)、OS(overall survival,OS)均具有明显的相关性(P<0.05);多因素生存分析,当PLN和LNR作为协变量分别进入Cox比例风险模型时,PLN和LNR均为患者RFS和OS的独立预测指标(P<0.001);当PLN和LNR作为协变量同时进入Cox比例风险模型时,LNR依然是患者RFS和OS的独立预测指标(RFS:P<0.001.OS:P=0.001),而PLN不再是其独立预测指标(RFS:P=0.944,0S:P=0.315)。结论:相对于PLN而言,LNR能更好的评价乳腺癌术后患者的复发风险和总生存时间,为乳腺癌危险度分级和临床医生制定辅助治疗方案提供更有力的参考依据。

大肠癌淋巴结转移规律的临床研究

目的 :探讨大肠癌区域淋巴结转移规律及术中判断淋巴结是否转移的准确性。方法 :对 170例可根治性大肠癌的手术标本常规病理切片诊断 ,分析淋巴结转移情况。结果 :大肠癌淋巴结阳性率、转移度与患者性别、年龄和肿瘤大小无明显关系 ,而与肿瘤部位、浸润深度有关 ,直肠癌或肿瘤浸润至肠壁外时 ,其淋巴结阳性率和淋巴结转移度显著高于结肠癌或肿瘤局限于肠壁内者 (P <0 0 5 ) ,淋巴结转移度和肿瘤细胞分化程度有关。 86例术中探及淋巴结肿大 ,84例未及肿大 ,术后证实分别有 5 6例和 46例淋巴结转移阳性。结论 :大肠癌淋巴结转移与肿瘤部位、浸润深度及分化程度有关 ,术中判断淋巴结是否转移并不准确 ,应常规作区域淋巴结清扫。

胆囊癌的淋巴转移特征及手术策略

目的分析胆囊癌（GBC）的淋巴转移特征,总结外科治疗经验,探讨淋巴转移相关指标对评判患者预后的价值。方法回顾性分析西安交通大学第一附属医院自2008年1月~2012年12月经根治性手术治疗的GBC患者162例,收集患者的一般资料、临床表现、影像学检查、实验室检查、病理检查、手术方式及生存时间,分析胆囊癌淋巴转移指标对预后的影响及相关手术策略。结果 162例患者中男性41例,女性121例,平均年龄（60.9±10.4）岁;R0切除147例（90.7%）,R1切除15例;腺癌142例（87.7%）,病理分级以中低分化为主（89.4%）;TNM分期：Ⅰ期5例（3.1%）,Ⅱ期4例（2.5%）,ⅢA期59例（36.4%）,ⅢB期46例（28.4%）,IVA期10例（6.2%）,IVB期38例（23.5%）。91例（56.2%）合并淋巴结转移,其中N1转移56例（61.5%）,N2转移35例（38.5%）。111例患者（68.5%）行D1淋巴结清扫,51例（31.5%）行D2淋巴结清扫。总体患者平均阳性淋巴结数（PLNC）为（1.9±2.6）个（0-12）,清扫所得总淋巴结总数平均值为（6.1±3.6）个（1-21）,平均淋巴结阳性率（LNR）为（0.33±0.37）（0-1）;总体中位生存时间为31.3m,1、3、5年生存率分别为61.0%、49.0%及45.7%;N0患者术后5年生存率为73.4%,N1＋患者5年生存率为22.6%,N2＋患者5年生存率为11.1%,差异具有统计学意义（P〈0.001）;N1＋患者行D1清扫与D2清扫的中位生存时间分别为8m与6.9m,5年生存率分别为26.2%及0%,组间差异无统计学意义（P=0.13）,但行D2清扫的患者中4例患者出现跳跃性转移;阳性淋巴结数（PLNC）=0、1-3、≥4患者5年生存率分别为73.4%、28.0%、0%（P〈0.001）,阳性淋巴结率（LNR）=0、0.01-0.6、〉0.6患者5年生存率分别为73.4%、24.7%、8.6%（P〈0.001）。单因素分析显示T分期、N分期、M分期、切缘、病理分级、PLNC、LNR影响患者预后,多因素分析显示切缘、N分期、M分期、病理分级、PLNC为患者预后的独立危险因素。结论淋巴转移影响胆囊癌患者的预后;D2淋巴结清扫可提高术后分期的准确性,故对根治性切除的患者都应行D2淋巴结清扫;阳性淋巴结数为胆囊癌患者预后的独立危险因素。

阳性淋巴结对数比在胸段食管鳞癌患者长期预后中的预测作用

目的评价阳性淋巴结对数比(LODDS)在预测不同胸段食管鳞癌患者长期预后中的作用。方法回顾性分析731例食管鳞癌根治术后患者临床资料,分析LODDS在全组患者、术后淋巴结阴性患者和术中清扫淋巴结数目<12枚患者中预测预后的价值。结果LODDS与阳性淋巴结个数和术中淋巴结清扫数目均显著相关(r=0.696、-0.530,均P=0.000)。ROC曲线分析结果显示LODDS最佳截点值为-1.028。多因素分析结果显示患者性别、年龄、食管病变部位、pT分期、阳性淋巴结个数和LODDS值为全组患者生存和术中淋巴结清扫数目≥12枚患者OS的独立影响因素(P<0.05);患者性别、年龄、食管病变部位、pT分期和LODDS值为术后淋巴结阴性患者生存的独立影响因素(P<0.05),而pT分期和LODDS值为术中淋巴结清扫数目<12枚患者OS的独立影响因素(P<0.05)。结论LODDS可以作为不同胸段食管鳞癌根治术后患者的独立性预后指标。

阳性淋巴结比值比在预测术前放化疗后直肠癌术后患者生存的价值

目的分析阳性淋巴结比值比(LNR)在预测术前放化疗(CRT)后直肠癌术后患者生存的价值。方法 133例局部进展期直肠癌患者,给予术前放化疗后进行了全直肠系膜切除术(TME),根据术后病理LNR将患者分成LNR=0、0<LNR≤0.15、0.15<LNR≤1.00组;或者有淋巴结转移的患者根据阳性LNR分成两组,并对各组的总生存时间(OS)和无病生存时间(DFS)进行比较。结果中位随访时间为40个月,所有患者的5年总生存率和无病生存率分别为88.0%和74.4%。LNR=0、 0<LNR≤0.15、0.15<LNR≤1.00的5年总生存率和5年无病生存率分别为96.7%、94.7%、42.9%和84.9%、73.0%、30.7%(P<0.05)。多因素分析显示,只有LNR是影响患者生存的独立预后因素(P<0.05)。对于术后淋巴结阳性患者,显示只有LNR是影响淋巴结阳性患者生存的独立预后因素(P<0.05)。结论术后阳性LNR是术前放化疗后接受全直肠系膜切除术治疗的局部晚期直肠癌患者的独立预后因素。

阳性淋巴结对数比对Ⅲ期结直肠癌预后的预测价值

目的探讨阳性淋巴结对数比(log odds of positive lymph nodes,LODDS)对Ⅲ期结直肠癌预后的预测价值。方法收集177例结直肠癌患者相关临床病理资料,记录患者的阳性淋巴结数、阴性淋巴结数,计算LODDS,按LODDS四分位数将患者分为四组,所有患者均完成5年的随访。结果四组患者在5年随访中,生存率分别为75.0%、57.1%、46.9%、43.2%。随着LODDS的增长,生存率也呈降低趋势。相对于LODDS最低四分位的患者,LODDS最高四分位患者的5年生存率明显下降(75.0%比43.2%,P<0.001)。多因素Cox回归分析表明LODDS、组织分化程度是Ⅲ期结直肠癌患者5年生存的独立预后因子。结论LODDS为Ⅲ结直肠癌的5年生存率的独立预后指标。

大肠癌淋巴结转移相关因素的多因素分析

目的探讨大肠癌淋巴结转移的相关因素,为临床诊断和治疗提供参考。方法对我院2000至2001年施行根治手术治疗的345例大肠癌的资料进行分类整理,用χ2检验及Logistic多因素回归分析各临床病理因素与淋巴结转移的关系。结果大肠癌淋巴结转移率、转移度与患者性别、肿瘤部位等无明显关系,而与浸润深度、淋巴管浸润、大体类型、组织学分级等有关。Logistic多因素回归分析表明,相关因素与淋巴结转移的相关程度依次为:肿瘤浸润深度、淋巴管浸润、大体类型、组织学分级、肿瘤类型、肿瘤大小。结论大肠癌淋巴结转移相关因素:浸润深度>淋巴管浸润,是影响淋巴结转移的最重要因素。