Prognosis of colorectal cancer patients is associated with the novel log odds of positive lymph nodes scheme: derivation and external validation
Prognosis of colorectal cancer patients is associated with the novel log odds of positive lymph nodes scheme: derivation and external validation
复制标题
结直肠癌患者的预后与阳性淋巴结方案的新对数几率相关：推导和外部验证
DOI：
10.7150/jca.38180
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Li, Xiao-Bo
中科院分区：
文献类型：
--
作者：
Zhang, Qing-Wei;Zhang, Chi-Hao;Li, Xiao-Bo
背景和目标：目的构建结直肠癌（CRC）淋巴结阳性对数比值（LODDS）分期方案的截断点，并进行外部验证。患者和方法：使用X-tile方法在来自监测、流行病学和最终结果（SEER）数据库的240，898例患者中找到新LODDS分期方案的截止点，并在来自国际多中心队列的1，878例患者中进行外部验证。采用Kaplan-Meier曲线和多变量考克斯比例风险模型研究新的LODDS分类的作用。结果：两组的预后临界值分别为-2.18和-0.23（P< 0.001）。在SEER数据库中，随着LODDS的增加，患者的5年癌症特异性生存率分别为83.8%、57.4%和24.4%（P< 0.001）。在外部国际多中心队列中，随着LODDS的增加，5年总生存率分别为77.2%、55.0%和26.7%（P< 0.001）。多变量生存分析确定了两个独立的数据库中的LODDS分类，患者的年龄，T分类，M状态和肿瘤分级作为独立的预后因素。对按肿瘤位置（结肠或直肠）、淋巴结数目（< 12或≥ 12）、TNM分期III、淋巴结阴性分层的患者亚组的分析也证实LODDS是两个独立数据库中的独立预后因素（P< 0.001）。结论：新的LODDS分类是CRC患者的独立预后因素，应计算pN方案的额外风险组分层。
Background and aim: To construct proper and externally validate cut-off points for log odds of positive lymph nodes scheme (LODDS) staging scheme in colorectal cancer (CRC). Patients and methods: The X-tile approach was used to find the cut-off points for the novel LODDS staging scheme in 240,898 patients from the Surveillance, Epidemiology and End Results (SEER) database and externally validated in 1,878 from the international multicenter cohort. Kaplan-Meier plot and multivariate Cox proportional hazard models were performed to investigate the role of the novel LODDS classification. Results: The prognostic cut-off values were determined as -2.18, and -0.23 (P< 0.001). Patients had 5-year cancer-specific survival rates of 83.8%, 57.4% and 24.4% with increasing LODDS (P< 0.001) in the SEER database. Five-year overall survival rates were 77.2%, 55.0% and 26.7% with increasing LODDS (P< 0.001) in the external international multicenter cohort. Multivariate survival analysis identified both the LODDS classification, the patient's age, the T category, the M status, and the tumor grade as independent prognostic factors in both two independent databases. The analyses of the subgroup of patients stratified by tumor location (colon or rectum), number of retrieved lymph node (< 12 or ≥ 12), TNM stage III, lymph node-negative also confirmed the LODDS as independent prognostic factors (P< 0.001) in both two independent databases. Conclusions: The novel LODDS classification was an independent prognostic factor for patients with CRCs and should be calculated for additional risk group stratification with pN scheme.