The assessment of the optimal number of examined lymph nodes and prognostic models based on lymph nodes for predicting survival outcome in patients with stage N3b gastric cancer.
gastric adenocarcinoma
log odds of metastatic lymph nodes (LODDS)
lymph node ratio (LNR)
prognostic model
the optimal number of lymph node retrieved
Journal
Asia-Pacific journal of clinical oncology
ISSN: 1743-7563
Titre abrégé: Asia Pac J Clin Oncol
Pays: Australia
ID NLM: 101241430
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
05
07
2019
accepted:
14
04
2020
pubmed:
8
8
2020
medline:
23
4
2021
entrez:
8
8
2020
Statut:
ppublish
Résumé
The optimal number of examined lymph nodes (ELNs) and the prognostic value of different nodal staging systems remain unclear in the context of N3b gastric cancer. To evaluate the optimal number of ELNs and compare the predictive ability of the ELN number, LN ratio (LNR), and log odds of metastatic LNs (LODDS) for overall survival (OS) in patients with resected stage N3b gastric adenocarcinoma in an international database. A total of 868 patients diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database (training cohort) and 144 patients diagnosed between 2011 and 2016 at the Liaoning Cancer Hospital (validation cohort) were identified. Cutoff values were established with X-tile. The 5-year OS rates were compared using Kaplan-Meier curves. Multivariate analysis was conducted with a Cox regression model. The Harrell's concordance index and Akaike's information criterion were used to compare the predictive accuracy of different nodal staging systems. The ELN number, LNR, and LODDS were independent prognostic factors for both the training and validation cohorts in the multivariate analysis. Patient with ≤26 ELNs, LNR of more than 0.9, and LODDS of more than 1.0 were associated with decrease OS. The LNR and LODDS had similar discriminatory ability for OS and performed better than the ELN number in the Eastern and Western populations. The optimal number of ELN may be 27 or more because LNs retrieved ≤26 was an independent risk factor for the prognosis. The prognostic prediction efficacy of LNR and LODDS was similar and better than that of ELN. Thus, LNR and LODDS could both serve as valid tools to predict OS for stage N3b patients.
Sections du résumé
BACKGROUND
BACKGROUND
The optimal number of examined lymph nodes (ELNs) and the prognostic value of different nodal staging systems remain unclear in the context of N3b gastric cancer.
AIM
OBJECTIVE
To evaluate the optimal number of ELNs and compare the predictive ability of the ELN number, LN ratio (LNR), and log odds of metastatic LNs (LODDS) for overall survival (OS) in patients with resected stage N3b gastric adenocarcinoma in an international database.
METHODS
METHODS
A total of 868 patients diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database (training cohort) and 144 patients diagnosed between 2011 and 2016 at the Liaoning Cancer Hospital (validation cohort) were identified. Cutoff values were established with X-tile. The 5-year OS rates were compared using Kaplan-Meier curves. Multivariate analysis was conducted with a Cox regression model. The Harrell's concordance index and Akaike's information criterion were used to compare the predictive accuracy of different nodal staging systems.
RESULTS
RESULTS
The ELN number, LNR, and LODDS were independent prognostic factors for both the training and validation cohorts in the multivariate analysis. Patient with ≤26 ELNs, LNR of more than 0.9, and LODDS of more than 1.0 were associated with decrease OS. The LNR and LODDS had similar discriminatory ability for OS and performed better than the ELN number in the Eastern and Western populations.
CONCLUSION
CONCLUSIONS
The optimal number of ELN may be 27 or more because LNs retrieved ≤26 was an independent risk factor for the prognosis. The prognostic prediction efficacy of LNR and LODDS was similar and better than that of ELN. Thus, LNR and LODDS could both serve as valid tools to predict OS for stage N3b patients.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e117-e124Subventions
Organisme : Department of Science and Technology of Liaoning Province
ID : 2018416017
Informations de copyright
© 2020 John Wiley & Sons Australia, Ltd.
Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: gLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394-424.
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115-132.
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439-449.
Posteraro B, Persiani R, Dall'Armi V, et al. Prognostic factors and outcomes in Italian patients undergoing curative gastric cancer surgery. Eur J Surg Oncol. 2014;40:345-351.
Takeshi S, Mitsuru S, Seiichiro Y, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy-Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767-2773.
Reid-Lombardo KM, Gay G, Patel-Parekh L, Ajani JA, Donohue JH. Treatment of gastric adenocarcinoma may differ among hospital types in the United States, a report from the National Cancer Data Base. J Gastrointest Surg. 2007;11:410-419. discussion 419-20.
de Manzoni G, Verlato G, Roviello F, et al. The new TNM classification of lymph node metastasis minimises stage migration problems in gastric cancer patients. Br J Cancer. 2002;87:171-174.
Deng J, Liu J, Wang W, et al. 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. Chin J Cancer Res. 2018;30:477-491.
Huang CM, Lin BJ, Lu HS, Zhang XF, Li P, Xie JW. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus. World J Gastroenterol. 2008;14:4383-4388.
Marchet A, Mocellin S, Ambrosi A, et al. The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series. Eur J Surg Oncol. 2008;34:159-165.
Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245:543-552.
Amri R, Klos CL, Bordeianou L, Berger DL. The prognostic value of lymph node ratio in colon cancer is independent of resection length. Am J Surg. 2016;212:251-257.
Taylor MD, LaPar DJ, Thomas CJ, et al. Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer. Ann Thorac Surg. 2013;96:1163-1170.
Wang J, Hassett JM, Dayton MT, Kulaylat MN. The prognostic superiority of log odds of positive lymph nodes in stage III colon cancer. J Gastrointest Surg. 2008;12:1790-1796.
Sun Z, Xu Y, Li de M, et al. Log odds of positive lymph nodes: a novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0 resection. Cancer. 2010;116:2571-2580.
Wang ZX, Qiu MZ, Jiang YM, Zhou ZW, Li GX, Xu RH. Comparison of prognostic nomograms based on different nodal staging systems in patients with resected gastric cancer. J Cancer. 2017;8:950-958.
Spolverato G, Ejaz A, Kim Y, et al. Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma. Ann Surg. 2015;262:991-998.
Seevaratnam R, Bocicariu A, Cardoso R, et al. How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. Gastric Cancer. 2012;15(Suppl 1):S70-88.
Camp RL, Marisa DF, Rimm DL. X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clinical Cancer Research. 2004;10:7252-7259.
Sano T, Coit DG, Kim HH, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: international Gastric Cancer Association staging project. Gastric Cancer. 2017;20:217-225.
Woo Y, Goldner B, Ituarte P, et al. Lymphadenectomy with optimum of 29 lymph nodes retrieved associated with improved survival in advanced gastric cancer: a 25,000-patient international database study. J Am Coll Surg. 2017;224:546-555.
Zhao B, Zhang J, Chen X, et al. The retrieval of at least 25 lymph nodes should be essential for advanced gastric cancer patients with lymph node metastasis: a retrospective analysis of single-institution database study design: cohort study. Int J Surg. 2017;48:291-299.
Hayashi S, Kanda M, Ito S, et al. Number of retrieved lymph nodes is an independent prognostic factor after total gastrectomy for patients with stage III gastric cancer: propensity score matching analysis of a multi-institution dataset. Gastric Cancer. 2019;22:853-863. https://doi.org/10.1007/s10120-018-0902-2.
Kim CY, Nam BH, Cho GS, et al. Learning curve for gastric cancer surgery based on actual survival. Gastric Cancer. 2016;19:631-638.
Jiang L, Yao Z, Zhang Y, et al. Comparison of lymph node number and prognosis in gastric cancer patients with perigastric lymph nodes retrieved by surgeons and pathologists. Chin J Cancer Res. 2016;28:511-518.
Kwon IG, Son T, Kim HI, Hyung WJ. Fluorescent lymphography-guided lymphadenectomy during robotic radical gastrectomy for gastric cancer. JAMA Surg. 2019;154:150-158. https://doi.org/10.1001/jamasurg.2018.4267.
Okusa T, Nakane Y, Boku T, et al. Quantitative analysis of nodal involvement with respect to survival rate after curative gastrectomy for carcinoma. Surg Gynecol Obstet. 1990;170:488-494.
Kutlu OC, Watchell M, Dissanaike S. Metastatic lymph node ratio successfully predicts prognosis in western gastric cancer patients. Surg Oncol. 2015;24:84-88.
Zhou Y, Zhang J, Cao S, Li Y. The evaluation of metastatic lymph node ratio staging system in gastric cancer. Gastric Cancer. 2013;16:309-317.
Hung YS, Chang SC, Liu KH, et al. A prognostic model based on lymph node metastatic ratio for predicting survival outcome in gastric cancer patients with N3b subclassification. Asian J Surg. 2019;42:85-92.
Kilic L, Ordu C, Ekenel M, et al. Comparison of two different adjuvant treatment modalities for pN3 gastric cancer patients after D2 lymph node dissection: can we avoid radiotherapy in a subgroup of patients? Med Oncol. 2013;30:660.
Liu H, Deng J, Zhang R, Hao X, Jiao X, Liang H. The RML of lymph node metastasis was superior to the LODDS for evaluating the prognosis of gastric cancer. Int J Surg. 2013;11:419-424.
Lee HS, Lee HE, Yang HK, Kim WH. Perigastric tumor deposits in primary gastric cancer: implications for patient prognosis and staging. Ann Surg Oncol. 2013;20:1604-1613.
Chen H, Tang Z, Chen L, et al. Evaluation of the impact of tumor deposits on prognosis in gastric cancer and a proposal for their incorporation into the AJCC staging system. Eur J Surg Oncol. 2018;44:1990-1996.
Sun Z, Wang ZN, Xu YY, et al. Prognostic significance of tumor deposits in gastric cancer patients who underwent radical surgery. Surgery. 2012;151:871-881.
Anup S, Lu J, Zheng CH, et al. Prognostic significance of perigastric tumor deposits in patients with primary gastric cancer. BMC Surg. 2017;17:84.