Prognostic significance of lymph node ratio in esophageal cancer

Wang, Nana; Jia, Yibin; Wang, Jianbo; Wang, Xintong; Bao, Cihang; Song, Qingxu; Tan, Bingxu; Cheng, Yufeng

doi:10.1007/s13277-014-2840-x

Cited by 29 publications

(33 citation statements)

References 32 publications

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“…Based on the these notion, the nomogram was performed well with an AUC of more than 0.7 compared to 7 th TNM staging. For the traditional TNM staging, some studies also thought it was controversial and proposed other different subdivision [11,29,30]. With repect to the clinical utility, we performed C-index, tdROC and Calibration plot and demonstrated it was effective predicting model in the external and internal validation.…”

Section: Discussionmentioning

confidence: 92%

Validation of a nomogram to predict survival in patients with ESCC based on examined lymph nodes

Liao

Cao

Chen

et al. 2020

Preprint

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Background: Current the number of examined LNs are controversial in predicting the survival of ESCC. We aimed to develop an alternative LN-classification-based nomogram to individualize ESCC prognosis.Methods: Using the data of patients diagnosed with ESCC from SEER database between 2004 and 2015, we determined the cut-off values for the number of LNs examined via the K-adaptive partitioning (KAPS) algorithm. A nomogram predicting the survival of ESCC was performed, internally and externally validated, and evaluated by calibration plot, C-index, and decision curve analysis, and compared to the 7th TNM stage.Results: Totally, we included 3629 patients with detailed information. The optimal cut-off for examined LN number was 8. The C-index for the nomogram was higher than the 7th TNM staging (internal: 0.708; 95%CI, 0.678-0.753 vs 0.601; 95%CI, 0.573-0.656, P<0.001; external: 0.687; 95%CI, 0.601-0.734 vs 0.605; 95%CI, 0.563-0.659, P<0.001). Additionally, the nomogram showed good agreement between internal and external validation. DCA analysis showed no matter in the internal cohort or external cohort, the nomogram showed a greater benefit across the period of follow-up compared to 7th TNM stage.Conclusion: We found examining LNs that was more than 8 benefited for prognosis of patients. Based on these, a nomogram with greater benefit for predicting survival of EC patients than TNM staging was constructed.

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Section: Discussionmentioning

confidence: 92%

Validation of a nomogram to predict survival in patients with ESCC based on examined lymph nodes

Liao

Cao

Chen

et al. 2020

Preprint

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“…Although the new pN stage was found to provide more accurate prediction of survival than the previous versions, this numberbased pN stage still had some de ciencies. [4,12,[17][18][19][20][21] The most important point was that stage migration usually occurred in this pN stage in patients with a small number of LNs examined. [22] The number of LNs examined could vary signi cantly among different patient cohorts due to the different extents of lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, few studies have evaluated these two LN staging systems in ESCC. [12,[17][18][19] In the current study, we used a large patient cohort with ESCC to compare the prognostic value of three LN staging systems (pN, LNR and LODDS). In order to minimize the impact of the pT stage on survival,…”

Section: Discussionmentioning

confidence: 99%

Comparison of three lymph node staging systems in evaluating the prognosis of patients with pT3 esophageal squamous cell carcinoma

Liu

Wang

Chen

et al. 2020

Preprint

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Background: To explore the prognostic value of three lymph node staging systems, including number of positive lymph nodes (pN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS), in patients with pT3 stage esophageal squamous cell carcinoma (ESCC).Methods: Data from 1667 patients with pT3 stage ESCC who underwent surgical resection were reviewed. The log-rank test was used to assess the differences in overall survival (OS) between groups. Multivariate analysis was performed to identify independent prognostic factors. The receiver operating characteristic curve was used to assess the prognostic accuracy of the three staging methods.Results: The median survival time for the entire group was 48.0 months, and the 1-, 3- and 5-year OS rates were 83.9%, 55.1% and 66.6%, respectively. All three lymph node staging systems were significantly correlated with OS in univariate and multivariate analyses. However, LNR and LODDS staging systems could more accurately predict survival than the pN staging system in patients with < 15 lymph nodes dissected, while LODDS have the best prognostic homogeneity.Conclusions: All three staging systems could be used for prognostic assessment in pT3 stage ESCC. But LODDS staging system might be superior to the others due to its prognostic homogeneity.

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“…Recently, the metastatic LN ratio (MLR) which was defined as the ratio of the metastatic LNs to the total dissected LNs was proposed to evaluate the prognosis of ESCC (16)(17)(18). He et al compared the use of pN stage and the MLR for determination of the prognosis of 353 patients with ESCC who were positive for LN metastasis following radical esophagectomy, and the results showed that a high MLR was independently and significantly associated with poor 5-year OS (19).…”

Section: Discussionmentioning

confidence: 99%

“…LN negative patients account for a large proportion in the overall esophageal cancer patients, which means that many patients do not survive from the two stage method. The LODDS are defined as the log of the ratio between the probability of being a positive LN and the probability of being a negative LN when one LN is dissected ,and has been proposed to be recently a superior prognostic indicator (compare to the pN or MLR classification) in other cancer, such as gastric cancer (15,16), pancreatic cancer and colorectal cancer (18)(19)(20). In addition, LODDS are not affected by the number of LN negative or positive, therefore, LODDS seem to have more advantages in terms of predicting prognosis of patients without LN metastasis.…”

Section: Discussionmentioning

confidence: 99%

Log odds of positive lymph nodes is a novel prognostic indicator for advanced ESCC after surgical resection

Yang

Zhang

et al. 2017

J. Thorac. Dis.

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Background: To investigate the prognostic value of the log odds of positive lymph nodes (LODDS) in patients with advanced esophageal squamous cell carcinoma (ESCC) after surgical resection. Methods: Clinical data of 260 patients with advanced ESCC undergoing surgical resection were retrospectively reviewed. Univariate and multivariate analysis were done using the chi-square test and Cox regression model. Receiver-operating-characteristic (ROC) curve was used to compare the association of pathologic nodal (pN) and LODDS with 3-or 5-year overall survival (OS). The cut-point analyses were performed to determine whether there was a cutoff LODDS related to the greatest OS difference. Results: The mean follow-up duration was 30 months (range, 3 to 106 months). The 1-, 3-, 5-year OS rates were 70.0%, 41.9% and 30.3%, respectively. Univariate analyses indicated that the 5-year OS rates were 51.2%, 30.5%, 24.6%, and 14.2% in LODDS1, LODDS2, LODDS3, and LODDS4, respectively, and the median survival times were 68.7, 34.6, 24.0, and 14.6 months, respectively (P=0.000) for all patients, and subgroup analysis showed the effect did not change in 155 patients without lymph node (LN) metastasis (P=0.024). Multivariate analysis showed that LODDS [hazard ratio (HR) =1.309, P=0.003] to be independent and significant prognostic factors for all patients, so as in node-negative patients LODDS (HR =1.610, P=0.038). The AUC of LODDS stage (AUC =0.630) was larger than that of pN stage (AUC =0.621) in prediction of 3-year OS, however LODDS were smaller in prediction of 5-year OS (AUC =0.620, 0.631, respectively), and the differences were not statistically significant (P>0.05 all). Lastly, the step analysis identified the best cut-off point for LODDS as −1.2 that is significantly associated with the prognosis of the node-negative patients (P=0.024), and the ROC analysis also indicated that a cut-off value of −1.2 for LODDS provided the highest sensitivity and specificity interestingly.Conclusions: LODDS may be suitable for evaluation of OS in advanced ESCC patients without LN metastasis.

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Prognostic significance of lymph node ratio in esophageal cancer

Cited by 29 publications

References 32 publications

Validation of a nomogram to predict survival in patients with ESCC based on examined lymph nodes

Validation of a nomogram to predict survival in patients with ESCC based on examined lymph nodes

Comparison of three lymph node staging systems in evaluating the prognosis of patients with pT3 esophageal squamous cell carcinoma

Log odds of positive lymph nodes is a novel prognostic indicator for advanced ESCC after surgical resection

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