Negative lymph node count as an independent prognostic factor in stage III patients after curative gastrectomy: A retrospective cohort study based on a multicenter database
Negative lymph node count as an independent prognostic factor in stage III patients after curative gastrectomy: A retrospective cohort study based on a multicenter database
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DOI：
10.1016/j.ijsu.2019.12.018
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发表时间：
2020-02-01
影响因子：
15.3
通讯作者：
Liang, Han
中科院分区：
文献类型：
--
作者：
Zhang, Nannan;Deng, Jingyu;Liang, Han
目的：目的：探讨III期胃癌根治术后淋巴结阴性（NLN）计数的预后价值。方法：回顾性分析2001 - 2011年2942例III期胃癌根治术患者的临床病理资料。仅包括具有>= 16个检查的淋巴结（ELN）的患者。经过生存分析，2942例患者被分为三个亚组，NLN计数为0，1-9和>= 10。分析亚组间的生存差异，以评估NLN计数对III期GC患者的分期迁移和总生存（OS）的影响。采用斯皮尔曼相关系数分析ELN计数与阳性淋巴结（PLN）计数、ELN计数与NLN计数、NLN计数与PLN计数之间的关系。结果：生存分析显示NLN计数与OS显著相关（P = 0.001），是III期胃癌患者预后的独立预测因子（P < 0.01）。亚组分析显示，当III期患者的NLN计数>= 10时，预后评估准确性最高。主要在以下病理肿瘤-淋巴结（pTN）亚组中检测到分期迁移：pT 2N 3a伴1-9个NLN和pT 2N 3b伴>= 10个NLN，pT 3 N3 a伴1-9个NLN和pT 3 N3 b伴>= 10个NLN。pT 2N 3和pT 3 N3期胃癌患者的NLN计数与ELN和PLN计数呈正相关（pT 2N 3期分别为r = 0.694和r = 0.881; pT 3 N3期分别为r = 0.685和r = 0.902; P < 0.001）。结论：NLN计数可提高胃癌TNM分期的预后预测效率，尤其是对Ⅲ期胃癌患者，值得临床推广应用。
Objective: To examine the prognostic value of negative lymph node (NLN) count in stage III gastric cancer (GC) patients after curative gastrectomy.Methods: The clinicopathological data of 2942 stage III patients who underwent curative gastrectomy between 2001 and 2011 were analyzed. Only patients with >= 16 examined lymph nodes (ELNs) were included. After cut-point survival analysis, the 2942 patients were divided into three subgroups with NLN counts of 0, 1-9, and >= 10. Survival differences among the subgroups were analyzed to assess the effects of NLN count on stage migration and overall survival (OS) in stage III GC patients. Spearman's correlation coefficient was used to assess the relationships between the ELN count and the positive lymph node (PLN) count, the ELN count and the NLN count, and the NLN count and the PLN count.Results: Survival analyses revealed that the NLN count was significantly associated with OS (P = 0.001) and was an independent predictor (P < 0.01) of prognosis in stage III GC patients. Subgroup analysis showed that the prognostic evaluation accuracy was highest when the NLN count was >= 10 for stage III patients. Stage migrations were mainly detected in the following pathological tumor-node (pTN) subgroups: pT2N3a with 1-9 NLNs and pT2N3b with >= 10 NLNs, and pT3N3a with 1-9 NLNs and pT3N3b with >= 10 NLNs. NLN count was positively correlated with the ELN and the PLN counts for pT2N3 and pT3N3 stage GC patients (r = 0.694 and r = 0.881 for pT2N3 patients; r = 0.685 and r = 0.902 for pT3N3 patients, respectively; P < 0.001). These findings indicate that the NLN count may be a useful prognostic predictor in stage III GC patients.Conclusions: The NLN count may improve the prognostic prediction efficiency of the tumor-node-metastasis (TNM) classification for GC, especially for stage III patients, and should be recommended for clinical applications.