The Positive Lymph Node Number and Postoperative N-Staging Used to Estimate Survival in Patients with Differentiated Thyroid Cancer: Results from the Surveillance, Epidemiology, and End Results Dataset (1988-2008)
The Positive Lymph Node Number and Postoperative N-Staging Used to Estimate Survival in Patients with Differentiated Thyroid Cancer: Results from the Surveillance, Epidemiology, and End Results Dataset (1988-2008)
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用于估计分化型甲状腺癌患者生存率的阳性淋巴结数量和术后 N 分期：来自监测、流行病学和最终结果数据集的结果（1988-2008 年）。
DOI：
10.1007/s00268-017-4343-6
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发表时间：
2018-06-01
影响因子：
2.6
通讯作者：
Ji, Qing-Hai
中科院分区：
文献类型：
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作者：
Wei, Wen-Jun;Lu, Zhong-Wu;Ji, Qing-Hai
淋巴结转移在评估分化型甲状腺癌（DTC）患者的预后时非常重要。然而，目前的N分期系统并不能充分反映DTC颈部淋巴结转移的临床意义。在本研究中，我们利用监测、流行病学和最终结果 (SEER) 登记的伴有淋巴结转移的 DTC 病例来确定是否可以使用阳性淋巴结编号 (PLNN) 来改善患者的生存分层。我们使用 SEER 数据集来识别 1988 年至 2008 年间检查的所有至少有一个颈部淋巴结阳性的 DTC 患者。使用多变量模型来比较癌症特异性生存 (CSS) 和总生存(OS) 并计算不同的 PLNN 截止点。SEER 中总共纳入了 14,359 名 pN + DTC 患者。在多变量 Cox 回归分析中，PLNN 与 CSS 和 OS 均显着相关，而淋巴结比率 (LNR) 和检查的淋巴结 (数量) (LNE) 均不显着相关。获得的最高C指数值（0.933）和最低AIC值（9362.687）表明PLNN比LNR或LNE更好地预测了DTC的CSS。由于 CSS 和 OS 的 p 值均最小化，并且 PLNN 在病例分组时表现最佳，因此 10 和 3/10 的 PLNN 截止点可有效地将 DTC 患者分别分为两个和三个级别。根据 3/10 三分法，评估每组放射性碘 (RAI) 治疗的益处。这种治疗为淋巴结转移超过10个的患者提供了约10%的生存获益。与不同统计模型下的LNR和LNE相比，PLNN在DTC分期方面优于LNR和LNE。 3/10 的截止点是根据预后对患者进行分层的最佳选择，并且对于 RAI 治疗选择具有临床意义。
Lymph node metastasis is important when evaluating the prognosis of patients with differentiated thyroid cancer (DTC). However, the current N-staging system cannot fully reflect the clinical significance of cervical lymph node metastasis in DTC. In this study, we employed Surveillance, Epidemiology, and End Results (SEER)-registered DTC cases with lymph node metastasis to determine whether the positive lymph node number (PLNN) could be used to improve stratification of patients in terms of survival.We used the SEER dataset to identify all DTC patients with at least one positive cervical lymph node who were examined between 1988 and 2008. Multivariable modeling was used to compare cancer-specific survival (CSS) and overall survival (OS) and to calculate different PLNN cutoff points.In total, 14,359 pN + DTC patients identified in the SEER were included. In multivariate Cox regression analysis, the PLNN was significantly associated with both CSS and OS, whereas neither the lymph node ratio (LNR) nor the (numbers of) lymph nodes examined (LNE) were so associated. The highest C-index value (0.933) and the lowest AIC value (9362.687) obtained indicated that the PLNN better predicted the CSS of DTC than did the LNR or LNE. As the p values for both CSS and OS were minimized, and as the PLNN performed best when cases were grouped, PLNN cutoff points of 10 and 3/10 efficiently stratified DTC patients into two and three levels, respectively. Based on the 3/10 trichotomy, the benefits of radioactive iodine (RAI) treatment were evaluated for each group. Such treatment afforded about a 10% survival benefit in patients with more than 10 lymph node metastases.Compared with the LNR and LNE under different statistical models, PLNN was superior in terms of DTC staging. A cutoff point of 3/10 was optimal for stratifying patients according to prognosis and was of clinical significance in terms of RAI treatment selection.