Evaluation of nodal status in intrahepatic cholangiocarcinoma: a population-based study.
Evaluation of nodal status in intrahepatic cholangiocarcinoma: a population-based study.
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肝内胆管癌淋巴结状态的评估：一项基于人群的研究
DOI：
10.21037/atm-21-2785
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发表时间：
2021-09
影响因子：
--
通讯作者：
Wang X
中科院分区：
文献类型：
--
作者：
Chen X;Rong D;Zhang L;Ni C;Han G;Lu Y;Chen X;Gao Y;Wang X
淋巴结转移（LNM）是肝内胆管癌（ICC）的一个公认的预后因素，但关于淋巴结状态的评估仍存在一些争议。因此，我们研究了淋巴结清扫（LND）的作用，比较了不同淋巴结分期系统的预后表现，然后开发并验证了预测ICC患者癌症特异性生存（CSS）的nomogram。研究队列取自监测、流行病学和最终结果数据库。通过计算赤池信息准则、贝叶斯信息准则、Harrell c指数和受者工作特征曲线下面积来评价不同分期模型。基于Cox回归模型构建CSS的nomogram，并通过标定曲线进行验证。采用决策曲线分析检验模型的临床应用价值。共纳入664例患者，其中331例（51.4%）患者接受了LND。淋巴结数量的增加没有显示出肿瘤学上的益处（P=0.876）。103例（31.1%）患者被确诊为LNM，这是其预后不良的原因（5年CSS为13.1%比44.9%，P<0.001）。倾向评分匹配后，无LNM患者不能从辅助治疗中获益（P=0.140）。根据约登指数，4个或更多的淋巴结可能足以进行准确的分期。淋巴结比（LNR）分类的最佳临界值为0.15，表现出最佳的预后效果。年龄、肿瘤大小、肿瘤数量、T分期、分级、LNR分型是ICC患者CSS的独立预测因素。根据独立因素预测ICC患者CSS的nomogram经过了很好的校准，比美国癌症联合委员会（united American Joint Committee on Cancer，第8版）分期系统具有更好的辨别力和更高的净收益。LNM是ICC的独立预后因素。虽然它没有显示出肿瘤学上的益处，但LND仍然应该被认为是一种分层患者的方法，有4个或更多的淋巴结回收可能足够这样做。LNR似乎是一种有希望且易于使用的淋巴结分期预测指标。所构建的nomogram可作为预测ICC患者CSS概率的有效工具。
Lymph node metastasis (LNM) is a well-established prognostic factor for intrahepatic cholangiocarcinoma (ICC), but there are still some controversies relating to the evaluation of nodal status. Therefore, we investigated the role of lymph node dissection (LND), compared the prognostic performances of different nodal staging systems, and then developed and validated a nomogram to predict cancer-specific survival (CSS) of ICC patients. The study cohort was taken from the Surveillance, Epidemiology, and End Results database. Akaike information criterion, Bayesian information criterion, Harrell’s C-index and area under the receiver operating characteristic curves were calculated to evaluate the different staging models. The nomogram for the CSS was constructed based on Cox regression models and validated by calibration curves. Decision curve analysis was introduced to examine the clinical value of the models. A total of 664 patients were enrolled, and 331 (51.4%) patients underwent LND. An increasing number of lymph nodes retrieved showed no oncologic benefit (P=0.876). LNM was identified in 103 (31.1%) patients, which was the cause of their poor prognoses (5-yr CSS 13.1% versus 44.9%, P<0.001). Patients without LNM could not benefit from adjuvant therapy after propensity score matching (P=0.140). Based on the Youden index, 4 or more lymph nodes retrieved might be adequate for accurate staging. The lymph node ratio (LNR) classification, with an optimal cut-off value of 0.15, displayed the best prognostic performance. Age, size, tumor number, T Stage, grade and the LNR classification were independent predictive factors for the CSS in ICC patients. The nomogram for predicting the CSS of ICC patients according to the independent factors was well calibrated and it showed better discrimination power and higher net benefits than the American Joint Committee on Cancer (8th edition) staging system. LNM is an independent prognostic factor in ICC. Although it shows no oncologic benefits, LND should still be considered as a method of stratifying patients, with 4 or more lymph nodes retrieved potentially enough to do so. LNR appears to be a promising and easy-to-use prognosticator for nodal staging. The constructed nomogram could serve as an effective tool to predict the CSS probabilities of ICC patients.
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影响因子：
2.2
作者：
Meng, Ze-Wu;Lin, Xiu-Quan;Chen, Yan-Ling
通讯作者：
Chen, Yan-Ling
影响因子：
3.2
作者：
Amini, Neda;Ejaz, Aslam;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
DOI：
10.1016/j.jamcollsurg.2015.09.012
发表时间：
2015-12-01
影响因子：
5.2
作者：
Bagante, Fabio;Gani, Faiz;Pawlik, Timothy M.
通讯作者：
Pawlik, Timothy M.
影响因子：
2.9
作者：
Pu, Ning;Gao, Shanshan;Burkhart, Richard A.
通讯作者：
Burkhart, Richard A.
影响因子：
3.8
作者：
Conci, S.;Ruzzenente, A.;Guglielmi, A.
通讯作者：
Guglielmi, A.