Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection

Abstract

This study aimed to assess the prognostic value of the hypothetical tumor-N-ratio (rN)-metastasis (TrNM) staging system in adenocarcinoma of the esophagogastric junction (AEG). The clinical data of 387 AEG patients who received surgical resection were retrospectively reviewed. The optimal cut-off point of rN was calculated by the best cut-off approach using log-rank test. Kaplan-Meier plots and Cox regressions model were applied for univariate and multivariate survival analyses. A TrNM staging system based on rN was proposed. The discriminating ability of each staging was evaluated by using an adjusted hazard ratio (HR) and a −2log likelihood. The prediction accuracy of the model was assessed by using the area under the curve (AUC) and the Harrell's C-index. The number of examined lymph nodes (LNs) was correlated with metastatic LNs (r = 0.322, P < 0.001) but not with rN (r = 0.098, P > 0.05). The optimal cut-points of rN were calculated as 0, 0~0.3, 0.3~0.6, and 0.6~1.0. Univariate analysis revealed that pN and rN classifications significantly influenced patients’ RFS and OS (P < 0.001). Multivariate analysis adjusted for significant factors revealed that rN was recognized as an independent risk factor. A larger HR, a smaller −2log likelihood and a larger prediction accuracy were obtained for rN and the modified TrNM staging system. Taken together, our study demonstrates that the proposed N-ratio-based TrNM staging system is more reliable than the TNM staging system in evaluating prognosis of AEG patients after curative resection.

Prognostic value of lymph node ratio in head and neck squamous cell carcinoma

“…Increased scrutiny in identifying an increased number of nodes potentially results in lower LNR. 5 In other types of cancer, the prognostic value of LNR has been studied as well, [6][7][8][9] also in comparison to the TNM classification system. However, this does not yet seem to have been translated in changes in therapeutic strategies or incorporation in staging systems.…”

Lymph Node Ratio Is an Independent Prognostic Factor for Patients with Siewert Type II Adenocarcinoma of Esophagogastric Junction: Results from a 10-Year Follow-up Study

“…However, the accuracy of predicting patient's prognosis that harvested su cient number of suspected metastatic LNs is markedly higher than those without adequate resection of potential involved LNs. A number of investigators have dedicated to identify and develop alternative reliable survival predicting factors or models for patients with gastrointestinal cancer, particularly after removal of the tumor, which could outperform the traditional pTNM staging method [20][21][22]. In this study, we de ned the optimal cut-off of LNR as LNR = 0, LNR between 0.01 and 0.40 and LNR > 0.41 using X-tile software [18].…”

“…The best cut-off for LNR in AEG remains undetermined presently. Most published studies on optimal cutoff of LNR values used an arbitrary calculation, mean values, or quartiles to discriminate patient groups based on their prognosis [22,24,25,27]. In this study, we determined the optimal cut-off using X-tile program.…”

Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

“…The LNR was de ned as the ratio between the number of metastatic lymph nodes and the TNLE. After reviewing the literature on AEG, we chose the LNR classi cation system with interval values of 0, 0-0.3, 0.3-0.6, and 0.6-1 [21]. The LODDS score was classi ed according to the method described by Chen et al [22] as follows: LODDS1 (-2.11 ≤ LODDS1 ≤-1), LODDS2 (-1 < LODDS2 ≤ -0.5), LODDS3 (-0.5 < LODDS3 ≤ 0) and LODDS4 (0 < LODDS4 ≤ 1.61).…”