What is the most accurate lymph node staging method for perihilar cholangiocarcinoma? Comparison of UICC/AJCC pN stage, number of metastatic lymph nodes, lymph node ratio, and log odds of metastatic lymph nodes
What is the most accurate lymph node staging method for perihilar cholangiocarcinoma? Comparison of UICC/AJCC pN stage, number of metastatic lymph nodes, lymph node ratio, and log odds of metastatic lymph nodes
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DOI：
10.1016/j.ejso.2016.12.007
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发表时间：
2017-04-01
期刊：
影响因子：
3.8
通讯作者：
Guglielmi, A.
中科院分区：
文献类型：
--
作者：
Conci, S.;Ruzzenente, A.;Guglielmi, A.
背景资料：我们比较了国际抗癌联盟/美国癌症联合委员会的预后表现，（UICC/AJCC）第7版pN分期、转移性LN数（MLN）、LN比率（LNR）和接受根治性手术的肝门周围胆管癌（PCC）患者的MLN对数比值（LODDS），以确定最佳LN分期方法。研究纳入了在一个三级肝胆转诊中心接受手术治疗PCC的99例患者。采用两种方法评估和比较不同LN分期方法的预测能力：一种是基于变量重要性和预测误差率的估计，另一种是基于受试者工作特征（ROC）曲线的计算。pN 0型49例（49.5%），pN 1型33例（33.3%），pN 2型10例（10.1%）。取出的LN的中位数为8。预测误差率从LODDS的42.7%到UICC/AJCC pN分期的47.1%。此外，LODDS是预测3年生存率的ROC曲线下面积（AUC）最高的变量（AUC = 0.71），随后为LNR（AUC = 0.60），MLN数量（AUC = 0.59）和UICC/AJCC pN分期结论：在接受PCC根治性手术的患者中，MLN、LNR和LODDS的数量似乎比UICC/AJCC pN分期更能预测生存。此外，LODDS似乎是最准确和预测LN分期方法。(C)2017 Elsevier Ltd，BASO -癌症外科协会和欧洲外科肿瘤学会。All rights reserved.
Background: We compared the prognostic performance of the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) 7th edition pN stage, number of metastatic LNs (MLNs), LN ratio (LNR), and log odds of MLNs (LODDS) in patients with perihilar cholangiocarcinoma (PCC) undergoing curative surgery in order to identify the best LN staging method.Methods: Ninety-nine patients who underwent surgery with curative intent for PCC in a single tertiary hepatobiliary referral center were included in the study. Two approaches were used to evaluate and compare the predictive power of the different LN staging methods: one based on the estimation of variable importance with prediction error rate and the other based on the calculation of the receiver operating characteristic (ROC) curve.Results: LN dissection was performed in 92 (92.9%) patients; 49 were UICC/AJCC pN0 (49.5%), 33 pN1 (33.3%), and 10 pN2 (10.1%). The median number of LNs retrieved was 8. The prediction error rate ranged from 42.7% for LODDS to 47.1% for UICC/AJCC pN stage. Moreover, LODDS was the variable with the highest area under the ROC curve (AUC) for prediction of 3-year survival (AUC = 0.71), followed by LNR (AUC = 0.60), number of MLNs (AUC = 0.59), and UICC/AJCC pN stage (AUC = 0.54).Conclusions: The number of MLNs, LNR, and LODDS appear to better predict survival than the UICC/AJCC pN stage in patients undergoing curative surgery for PCC. Moreover, LODDS seems to be the most accurate and predictive LN staging method. (C) 2017 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.