Validation of clinical significance of examined lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system
Validation of clinical significance of examined lymph node count for accurate prognostic evaluation of gastric cancer for the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system
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验证检查淋巴结计数对于第八版美国癌症联合委员会 (AJCC) TNM 分期系统准确评估胃癌预后的临床意义
DOI：
10.21147/j.issn.1000-9604.2018.05.01
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发表时间：
2018-10-01
影响因子：
5.1
通讯作者：
Liang, Han
中科院分区：
文献类型：
--
作者：
Deng, Jingyu;Liu, Jinyuan;Liang, Han
目的探讨在中国多个医学中心提高胃癌根治术后淋巴结检查数（ELN）对提高胃癌患者预后评估准确性的必要性。方法回顾性分析2001 - 2011年7 620例胃癌根治性切除患者的临床病理资料，探讨ELN计数对提高胃癌患者术后预后评估的准确性是否不可或缺。在使用临界点生存分析进行细致分层后，所有纳入的7，620例患者被分为三组：小于16（<16），16 - 30（16 - 30）和大于30（>30）ELN。根据GC患者的总生存率（OS），分析不同亚组GC患者的生存差异，以评估ELN计数对分期迁移的影响。结果7,620例胃癌患者的生存分析显示ELN计数与OS呈正相关（P=0.001），是独立的预后预测因子（P<0.01）。分层分析显示，淋巴结阴性患者ELN计数≥ 16（≥16），淋巴结阳性患者ELN计数≥ 30，可提高预后评估的准确性。主要在具有特定pN分期的患者的各个亚组中检测到分期迁移，如下所示：pN 0有16−30 ELN（pN 016 −30）和pN 0有>30 ELN（pN 0>30），pN 0有<16 ELN（pN 0 <16）和pN 1>30，pN 1 <16和pN 216 −30，pN 116 −30和pN 2>30，pN 3a <16和pN 3b 16 −30，和pN 3a <16 and pN3b>30。这些发现表明，增加ELN计数是保证准确评估GC患者预后的先决条件。结论ELN计数>30是判断胃癌患者预后的准确指标，尤其是淋巴结阳性患者。
Objective To validate the necessity of increasing the examined lymph node (ELN) count for enhancing the accuracy of prognostic evaluation of gastric cancer (GC) patients after curative gastrectomy in multiple medical centers of China. Methods The clinicopathological data of 7,620 patients who underwent the curative resection for GC between 2001 and 2011 were included to demonstrate whether the ELN count is indispensable for enhancing the accuracy of prognostic evaluation of GC patients after surgery. After a meticulous stratification by using the cut-point survival analysis, all included 7,620 patients were allocated into three groups as: less than 16 (<16), between 16 and 30 (16−30), and more than 30 (>30) ELNs. Survival differences among various subgroups of GC patients were analyzed to assess the impact of the ELN count on the stage migration in accordance with the overall survival (OS) of GC patients. Results Survival analyses revealed that the ELN count was positively correlated with the OS (P=0.001) and was an independent prognostic predictor (P<0.01) of 7,620 GC patients. Stratum analysis showed that the accuracy of prognostic evaluation could be enhanced when the ELN count was no less than 16 (≥16) for node-negative patients and >30 for node-positive patients. Stage migrations were mainly detected in the various subgroups of patients with specific pN stages as follows: pN0 with 16−30 ELNs (pN016−30) and pN0 with >30 ELNs (pN0 >30), pN0 with <16 ELNs (pN0 <16) and pN1>30, pN1<16 and pN216−30, pN116−30 and pN2>30, pN3a<16 and pN3b16−30, and pN3a<16 and pN3b>30. These findings indicate that increasing the ELN count is a prerequisite to guarantee precisely prognostic evaluation of GC patients. Conclusions The ELN count should be proposed to be >30 for acquiring the accurate prognostic evaluation for GC patients, especially for node-positive patients.