本研究旨在提出一种基于淋巴结比例(LNR)的ypN (r-ypN)分类方法，并探讨其对新辅助治疗后食管癌的预后价值。

从国家癌症数据库(NCDB)提取7195例接受新辅助放化疗的食管癌患者的数据。四个r-ypN阶段由3个LNR阈值定义(使用X-tile软件为0%、10%和20%)。通过单独改变N个类别，开发修订的ypTNM (r-ypTNM)分类。Kaplan-Meier方法和Cox比例风险模型用于生存分析。使用赤池信息量准则(AIC)和C指数来比较当前分类和修订分类的预测性能。使用来自NEOCRTEC5010临床试验的独立队列进行外部验证。

ypN (P<0.001)和r-ypN (P<0.001)均为食管癌患者总生存期(OS)的独立预后因素。 Kaplan-Meier曲线显示r-ypN比ypN类别具有更好的辨别力。 在各ypN类(ypN3除外)中，r-ypN层的OS差异显著; 各r-ypN类别中ypN层间差异不显著(r-ypN3除外)。 r-ypN (AIC: 60752 vs 60782; c指数:0.591 vs 0.587)和r-ypTNM (AIC: 60623 vs 60628; c指数:0.613 vs 0.610)比现有分期系统具有更好的预测性能，AIC更低(校准更好)，c指数更高(鉴别能力更强)。 使NEOCRTEC5010队列的外部验证也证实了这一优势 

Abstract

Objective: This study aimed to propose a revised ypN (r-ypN) classification based on lymph node ratio (LNR) and to examine its prognostic value in postneoadjuvant esophageal cancer.

Background: A new postneoadjuvant pathologic (ypTNM) staging classification has been introduced for esophageal cancer. However, the ypN classification currently defined by the number of positive lymph nodes is influenced by the extent of lymphadenectomy.

Methods: Data on 7195 esophageal cancer patients receiving neoadjuvant chemoradiation were extracted from the National Cancer Database (NCDB). Four r-ypN stages were defined by 3 LNR thresholds (0%, 10%, and 20% using X-tile software). A revised ypTNM (r-ypTNM) classification was developed by solely changing N categories. Kaplan-Meier method and Cox proportional hazards models were used for survival analyses. Akaike information criterion (AIC) and Harrell's concordance index (C-index) were used to compare the predictive performance of the current and the revised classification. External validation was performed using an independent cohort from the NEOCRTEC5010 clinical trial.

Results: Both ypN (P<0.001) and r-ypN (P<0.001) were independent prognostic factors of overall survival (OS) for esophageal cancer patients. Kaplan-Meier curves demonstrated a better discrimination with r-ypN than ypN categories. Within each ypN category (except ypN3), OS was significantly different comparing r-ypN strata; however, there were no differences between ypN strata within each r-ypN category (except r-ypN3). r-ypN (AIC: 60752 vs 60782; C-index: 0.591 vs 0.587) and r-ypTNM (AIC: 60623 vs 60628; C-index: 0.613 vs 0.610) showed better predictive performance than the current staging system, with a lower AIC (better calibration) and higher C-index (improved discrimination). This advantage was also confirmed by external validation using the NEOCRTEC5010 cohort.

Conclusions: LNR showed better performance than ypN in predicting OS of esophageal cancer patients after neoadjuvant chemoradiation and may be an improvement on the current staging system.

原文链接

https://www.researchgate.net/publication/361806771_Lymph_Node_Ratio_Improves_Prediction_of_Overall_Survival_in_Esophageal_Cancer_Patients_Receiving_Neoadjuvant_Chemoradiotherapy_A_National_Cancer_Database_Analysis

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