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Can lymph node ratio replace pn categories in the tumor-node-metastasis classification system for esophageal cancer?
J Thorac Oncol. 2014 Aug; 9(8):1214-21.JT

Abstract

BACKGROUND

We evaluated the prognostic value of lymph node ratio (LNR) in esophageal squamous cell carcinoma (ESCC) patients after tri-incisional esophagectomy by making comparisons with pN categories in the UICC/AJCC (International Union Against Cancer/American Joint Committee on Cancer) classification system (seventh edition).

METHODS

Seven hundred ESCC patients underwent tri-incisional esophagectomy at our center (1988-2008) without neoadjuvant therapy. The adjusted X-tile cutoff values for LNR of 0 and 0.25 were compared with those in UICC/AJCC pN categories.

RESULTS

Univariate and multivariate analyses identified LNR as a significant prognostic factor regardless of the number of retrieved LNs. Spearman's correlation analysis showed close linear correlations between the number of examined and metastatic LNs (r = 0.205, p < 0.001), but not between the number of examined LNs and LNR (r = 0.058, p = 0.123). Significant prognostic differences were seen among LNR categories in all pT categories (p < 0.05), but not in pN categories stratified by tumor status (except T3: p < 0.001). Significant prognostic difference was seen among LNR categories in all pN categories (p < 0.05), but not between pN categories in all LNR categories (p > 0.05). Significant differences in 5-year cancer-specific survival rates were found among retrieved-node groups in the same pN category (except N2+3: p = 0.733), but not within the same LNR category (except N0: p < 0.001).

CONCLUSIONS

LNR is an independent prognostic factor after tri-incisional esophagectomy, regardless of the number of retrieved LNs. In ESCC, LNR might reduce stage migration, have more potential for predicting patient outcomes, and compensate for deficiencies in UICC/AJCC pN categories.

Authors+Show Affiliations

*State Key Laboratory of Oncology in South China; and †Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25157776

Citation

Tan, Zihui, et al. "Can Lymph Node Ratio Replace Pn Categories in the Tumor-node-metastasis Classification System for Esophageal Cancer?" Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer, vol. 9, no. 8, 2014, pp. 1214-21.
Tan Z, Ma G, Yang H, et al. Can lymph node ratio replace pn categories in the tumor-node-metastasis classification system for esophageal cancer? J Thorac Oncol. 2014;9(8):1214-21.
Tan, Z., Ma, G., Yang, H., Zhang, L., Rong, T., & Lin, P. (2014). Can lymph node ratio replace pn categories in the tumor-node-metastasis classification system for esophageal cancer? Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer, 9(8), 1214-21. https://doi.org/10.1097/JTO.0000000000000216
Tan Z, et al. Can Lymph Node Ratio Replace Pn Categories in the Tumor-node-metastasis Classification System for Esophageal Cancer. J Thorac Oncol. 2014;9(8):1214-21. PubMed PMID: 25157776.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can lymph node ratio replace pn categories in the tumor-node-metastasis classification system for esophageal cancer? AU - Tan,Zihui, AU - Ma,Guowei, AU - Yang,Haoxian, AU - Zhang,Lanjun, AU - Rong,Tiehua, AU - Lin,Peng, PY - 2014/8/27/entrez PY - 2014/8/27/pubmed PY - 2015/5/15/medline SP - 1214 EP - 21 JF - Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer JO - J Thorac Oncol VL - 9 IS - 8 N2 - BACKGROUND: We evaluated the prognostic value of lymph node ratio (LNR) in esophageal squamous cell carcinoma (ESCC) patients after tri-incisional esophagectomy by making comparisons with pN categories in the UICC/AJCC (International Union Against Cancer/American Joint Committee on Cancer) classification system (seventh edition). METHODS: Seven hundred ESCC patients underwent tri-incisional esophagectomy at our center (1988-2008) without neoadjuvant therapy. The adjusted X-tile cutoff values for LNR of 0 and 0.25 were compared with those in UICC/AJCC pN categories. RESULTS: Univariate and multivariate analyses identified LNR as a significant prognostic factor regardless of the number of retrieved LNs. Spearman's correlation analysis showed close linear correlations between the number of examined and metastatic LNs (r = 0.205, p < 0.001), but not between the number of examined LNs and LNR (r = 0.058, p = 0.123). Significant prognostic differences were seen among LNR categories in all pT categories (p < 0.05), but not in pN categories stratified by tumor status (except T3: p < 0.001). Significant prognostic difference was seen among LNR categories in all pN categories (p < 0.05), but not between pN categories in all LNR categories (p > 0.05). Significant differences in 5-year cancer-specific survival rates were found among retrieved-node groups in the same pN category (except N2+3: p = 0.733), but not within the same LNR category (except N0: p < 0.001). CONCLUSIONS: LNR is an independent prognostic factor after tri-incisional esophagectomy, regardless of the number of retrieved LNs. In ESCC, LNR might reduce stage migration, have more potential for predicting patient outcomes, and compensate for deficiencies in UICC/AJCC pN categories. SN - 1556-1380 UR - https://www.unboundmedicine.com/medline/citation/25157776/Can_lymph_node_ratio_replace_pn_categories_in_the_tumor_node_metastasis_classification_system_for_esophageal_cancer L2 - https://linkinghub.elsevier.com/retrieve/pii/S1556-0864(15)30654-7 DB - PRIME DP - Unbound Medicine ER -