| 鲁建亮,宋 昕,赵学科.阳性淋巴结对数比对食管鳞癌患者术后生存期的影响[J].肿瘤学杂志,2018,24(6):580-586. |
| 阳性淋巴结对数比对食管鳞癌患者术后生存期的影响 |
| Prognostic Value of Log Odds of Positive Lymph Nodes in Patients with Esophageal Squamous Cell Carcinoma |
| 投稿时间：2018-04-01 |
| DOI：10.11735/j.issn.1671-170X.2018.06.B010 |
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| 中文关键词: 阳性淋巴结对数比 pN分期 食管鳞癌 预后 |
| 英文关键词:LODDS pN stage ESCC prognosis |
| 基金项目:国家科技部863项目资助（SQ2015AA0202183）；国家自然科学基金委员会，广东省联合重大项目资助（U1301227） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨阳性淋巴结对数比（log odds of positive lymph nodes，LODDS）对食管鳞癌（esophageal squamous cell carcinoma，ESCC）患者，特别是淋巴结转移阴性患者术后生存期的影响，为淋巴结转移精准分期提供依据。［方法］ 5077例行食管癌根治术的ESCC患者（1976～2015年）均来自郑州大学第一附属医院河南省食管癌重点开放实验室50万例食管癌和贲门癌临床信息数据库。采用Cox多因素回归模型进行多因素分析，Log-rank法比较组间生存率；使用受试者工作特征曲线（receiver operating characteristic curve，ROC曲线)和曲线下面积（area under curve，AUC）比较pN分期和LODDS分期系统的预后评价能力。截点值分析探讨是否有一个最佳LODDS截点值使生存差异最大。［结果］ 对于淋巴结转移阴性ESCC患者，LODDS最佳的截点值是-1.2（即淋巴结取材数目为8枚），LODDS小于-1.2（即淋巴结取材数目为8枚以上）时，其与淋巴结转移阴性ESCC患者预后明显相关（χ2=4.780，P=0.029），且ROC曲线分析也显示LODDS的最佳截点值为-1.2时约登指数最大。LODDS分期的AUC大于pN分期（0.632 vs 0.610，P<0.001）。多因素Cox回归分析显示：性别（HR=0.863，P<0.001）、年龄（HR=1.295，P=0.008）、家族史（HR=0.912，P=0.016）、肿瘤部位(HR=0.863，P<0.001)、分化程度(HR=0.849，P<0.001)、T分期(HR=1.190，P=0.011)、LODDS分期(HR=1.080，P=0.008)是食管鳞癌患者的独立预后影响因素。［结论］ LODDS定量分析对淋巴结转移阴性的ESCC患者的预后判断有一定意义，淋巴结取材数目8枚以上（LODDS小于-1.2）的患者预后较好，提示对淋巴结转移阴性ESCC患者淋巴结清扫数目应为8枚以上；LODDS是影响ESCC患者的独立预后影响因素。 |
| 英文摘要: |
| Abstract：［Objective］ To examine the prognostic value of log odds of positive lymph nodes (LODDS) in patients with esophageal squamous cell carcinoma(ESCC) after radical esophagectomy. ［Methods］ Clinical data of 5077 patients with ESCC undergoing radical esophagectomy during 1976 to 2015，from the database of Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University，were analyzed. Multivariable analysis was performed using Cox proportional hazard regression model，and difference of survival between different groups was compared by Log-Rank method. The prognostic value of the pN stage and the LODDS stage were compared by receiver operating characteristic curve(ROC curve) and the area under curve(AUC). The cut-off value of LODDS for predicting the overall survival was determined. ［Results］ The AUC of LODDS was larger than that of pN stage（0.632 vs 0.610，P<0.001）. The LODDS value -1.2 was set as the cut-off point with the highest Youden index，which indicated that the number of lymph nodes harvested >8 was significantly associated with the prognosis of the node-negative ESCC patients(χ2=4.780，P=0.029). Multivariate Cox regression analysis showed that gender (HR=0.863，P<0.001)，age(HR=1.295，P=0.008)，family history(HR=0.912，P=0.016)，tumor location (HR=0.863，P<0.001)，differentiation (HR=0.849，P<0.001)，T stage (HR=1.190，P=0.011) and LODDS value (HR=1.080，P=0.008) were the independent prognostic factors of ESCC patients. ［Conclusion］ LODDS is a independent prognostic factor for ESCC patients. The study suggests that if the number of lymph node dissected more than 8，patients with node-negative ESCC would have a better prognosis. |
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