The tumor-log odds of positive lymph nodes-metastasis staging system, a promising new staging system for gastric cancer after D2 resection in China.
The tumor-log odds of positive lymph nodes-metastasis staging system, a promising new staging system for gastric cancer after D2 resection in China.
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DOI：
10.1371/journal.pone.0031736
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Xu RH
中科院分区：
文献类型：
--
作者：
Qiu MZ;Qiu HJ;Wang ZQ;Ren C;Wang DS;Zhang DS;Luo HY;Li YH;Xu RH
在本研究中，我们建立了一个假设的肿瘤-淋巴结-转移（TLM）和肿瘤-比率-转移（TRM）分期系统。并与第7版美国癌症联合委员会肿瘤-淋巴结-转移（AJCC TNM）分期系统进行比较。共选择了1000例在我中心接受治疗的胃癌患者进行分析。最后，对730例接受D2切除术的患者进行了回顾性研究。采用TLM、TRM和第7版AJCC TNM系统对患者进行分期。采用考克斯回归模型进行生存分析。我们使用两个参数来比较TNM、TRM和TLM分期系统，即-2log似然率和风险比。将淋巴结比率（LNR）的分割点设定为0、0-0.3、0.3-0.6、0.6-1.0。对于阳性淋巴结的对数几率（LODDS），临界点被确定为≤-0.5，-0.5-0，0-0.5，>0.5。对于每个pN或LNR组，不同LODDS分类的患者的生存率有显著差异。当按LODDS分类分层时，相应的pN或LNR分类中的预后高度同源。多因素分析显示TLM分期系统对预后的评估优于TRM或TNM系统。TLM系统对胃癌D2切除术后患者的预后评估优于TRM或TNM系统，具有上级价值。
In this study, we established a hypothetical tumor-lodds-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. Moreover, we compared them with the 7th edition of American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM) staging system in gastric cancer patients after D2 resection. A total of 1000 gastric carcinoma patients receiving treatment in our center were selected for the analysis. Finally, 730 patients who received D2 resection were retrospectively studied. Patients were staged using the TLM, TRM and the 7th edition AJCC TNM system. Survival analysis was performed with a Cox regression model. We used two parameters to compare the TNM, TRM and TLM staging system, the −2log likelihood and the hazard ratio. The cut points of lymph node ratio (LNR) were set as 0, 0–0.3, 0.3–0.6, 0.6–1.0. And for the log odds of positive lymph nodes (LODDS), the cut points were established as≤−0.5, −0.5-0, 0-0.5, >0.5. There were significant differences in survival among patients in different LODDS classifications for each pN or LNR groups. When stratified by the LODDS classifications, the prognosis was highly homologous between those in the according pN or LNR classifications. Multivariate analysis showed that TLM staging system was better than the TRM or TNM system for the prognostic evaluation. The TLM system was superior to the TRM or TNM system for prognostic assessment of gastric adenocarcinoma patients after D2 resection.
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