Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Wang, Jieyu; Li, Jun; Chen, Ruifang; Lu, Xin

doi:10.1002/cam4.1680

Cited by 11 publications

(13 citation statements)

References 42 publications

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“…Lymph node ratio (LNR), defined as the ratio of the number of metastatic lymph nodes (MLNs) to the number of resected lymph nodes (RLNs)11, has been proved as an independent prognostic predictor in several malignancies including nonsmall cell lung cancer12, breast cancer13, cervical cancer14, endometrial cancer15, and EOC 8, 16-19. However, the previous studies investigated the survival predictive value of LNR in all histologic subtypes of EOC and did not validate their results in another independent population 8, 16-19…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

Nie

Mao

2019

J. Cancer

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Background: Ovarian clear cell carcinoma (OCCC) has a worse prognosis compared to other histological subtypes. Although the survival effect of lymph nodes ratio (LNR) on ovarian carcinoma have been elucidated in several studies, the prognostic effect of LNR in OCCC has not been separately studied. This study aimed to investigate the prognostic significance of LNR in FIGO stage III OCCC.Methods: Patients with FIGO stage III OCCC who underwent primary cytoreductive surgery and systematic lymphadenectomy from January 2008 to June 2014 in two independent hospitals were retrospectively reviewed. Two independent patients cohorts were used to investigate the survival impact of LNR by using Kaplan-Meier and Cox regression proportional hazard method.Results: In training cohort, the 5-year progression-free survival (PFS) rates was 32.4% for patients with LNR ≤ 25%, and 19.8% for patients with LNR > 25%, respectively (p = 0.017). The 5-year overall survival (OS) rates was 41.3% for patients with LNR ≤ 25%, and 25.8% for patients with LNR > 25%, respectively (p = 0.003). In multivariate analysis, increased LNR was correlated with a poorer DFS (HR = 2.12 ,95% CI 1.32-3.41, p = 0.002) and OS (HR = 2.29, 95% CI 1.37-5.12, p = 0.001). These results were verified in a validation cohort.Conclusions: LNR is an independent survival predictor in patients with FIGO stage III OCCC.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

Nie

Mao

2019

J. Cancer

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“…Other research, directed by Wang et al . [ 20 ], has also shown that an increasing number of resected lymph nodes correlated with a significant improvement in OS for FIGO stage II and III cases of the disease. However, for FIGO stage IV patients, an improved OS was not significantly associated with a more extensive lymphadenectomy.…”

Section: Discussionmentioning

confidence: 98%

“…[ 18 ] showed that a value greater than 3 PLN is an independent predictive factor in a poor prognosis for patients with clear cell OC aside from the number of lymph nodes removed (comparing groups with < 10 removed and > 10 removed) [ 18 ]. However, the number of PLN is dependent on many factors, such as the surgeon’s and pathologist’s experience, anatomical variation, or the extent of the tumor [ 19 ], and this PLN figure does not provide or infer any information about the number of negative lymph nodes [ 20 ]. It is why the LNR value has been found in several studies to be a more accurate predictor [ 15 , 17 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the number of PLN is dependent on many factors, such as the surgeon’s and pathologist’s experience, anatomical variation, or the extent of the tumor [ 19 ], and this PLN figure does not provide or infer any information about the number of negative lymph nodes [ 20 ]. It is why the LNR value has been found in several studies to be a more accurate predictor [ 15 , 17 , 20 ]. Our study indicated similar results; for instance, in our multivariate survival analysis, the LNR was the only significant predictor of patient OS, while the number of lymph node metastases and the extracapsular involvement were not found to be independent factors.…”

Section: Discussionmentioning

confidence: 99%

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The association between lymph node metastases and long-term survival in patients with epithelial ovarian cancer

Lepinay

Szubert

Lewandowska

et al. 2020

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“…A value of 0.5 is added to both numerator and denomination to avoid singularity ( 15 , 16 ). The LODDS also showed superiority in predicting outcomes in bladder ( 17 ), colorectal ( 18 ), lung ( 19 ), ovarian ( 20 ), and esophageal ( 21 ) cancers. In this study, we performed a large population-based database investigation of the prognostic values of RLNs, PLNs, NLNs, LNR, and LODDS in SBNETs, which may inform treatment options and prognosis discussions and guide eligibility for clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Performance of Different Lymph Node Staging Systems in Patients With Small Bowel Neuroendocrine Tumors

Jiang

Xie

et al. 2020

Front. Endocrinol.

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Background: The prognostic significance of the lymph node (LN) classification for small bowel neuroendocrine tumors (SBNETs) remains unknown. The aim of the present study was to evaluate and compare the prognostic assessment of different LN staging systems. Methods: Patients with SBNETs were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The X-tile program was used to determine the cutoff value of the resected lymph nodes (RLNs), negative lymph nodes (NLNs), lymph node ratio (LNR), and the log odds of positive lymph nodes (LODDS). Survival analyses were performed using Kaplan–Meier curves with log-rank test. Logistic regression analysis was used to evaluate the differences between different periods. Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of different LN staging systems on cause-specific survival (CSS). The relative discriminative abilities of the different LN staging systems were assessed using the Akaike information criterion (AIC) and the Harrell consistency index (HCI). Result: A total of 3,680 patients were diagnosed with SBNETs between 1988 and 2014 from the SEER database. A significant difference over time (1988–1999 vs. 2000–2014) was seen in age ( P <0.001), tumor differentiation ( P <0.001), T stage ( P <0.001), and RLN ( P <0.001) subgroups. Multivariate Cox survival analysis identified that LN status stratified by the number of RLNs, NLNs, LNR, and LODDS all predicted CSS in patients with SBNETs (all P <0.05), whereas the number of positive lymph nodes (PLNs) failed ( P = 0.452). When assessed using categorical variables, LODDS staging systems showed the best prognostic performance (HCI: 0.766, AIC: 7,575.154) in the whole population. Further analysis based on different RLNs after eliminating the missing data showed that when the RLNs are <12, the LODDS (HCI: 0.769, AIC: 1,088.731) maintained the best prognostic performance as well when the RLNs are ≥12 (HCI: 0.835, AIC: 825.692). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that were better stratified and characterized by the LODDS. Conclusion: LODDS was a better predicator of survival when LN status was stratified as a categorical variable and should be considered when assessing the prognosis of patients with SBNETs to allow a more reliable means to stratify patient survival.

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Survival effect of different lymph node staging methods on ovarian cancer: An analysis of 10 878 patients

Cited by 11 publications

References 42 publications

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

Prognostic value of lymph nodes ratio in patients with stage III ovarian clear cell carcinoma: A retrospective study of patients in Southwest China

The association between lymph node metastases and long-term survival in patients with epithelial ovarian cancer

Prognostic Performance of Different Lymph Node Staging Systems in Patients With Small Bowel Neuroendocrine Tumors

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