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Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy.
Sci Rep. 2016 12 12; 6:38804.SR

Abstract

This study aimed to evaluate the prognostic significance of lymph node ratio (LNR) by establishing a hypothetical tumor-ratio-metastasis (TRM) staging system in patients with esophageal squamous cell carcinoma (ESCC). The records of 387 ESCC patients receiving curative esophagectomy were retrospectively investigated. The optimal cut-point for LNR was assessed via the best cut-off approach. Potential prognostic parameters were identified through univariate and multivariate analyses. A novel LNR-based TRM stage was proposed. The prognostic discriminatory ability and prediction accuracy of each system were determined using hazard ratio (HR), Akaike information criterion (AIC), concordance index (C-index), and area under the receiver operating characteristic curve (AUC). The optimal cut-points of LNR were set at 0, 0~0.2, 0.2~0.4, and 0.4~1.0. Multivariate Cox analysis indicated that the LNR category was an independent risk factor of overall survival (P < 0.001). The calibration curves for the probability of 3- and 5-year survival showed good consistency between nomogram prediction and actual observation. The LNR category and TRM stage yielded a larger HR, a smaller AIC, a larger C-index, and a larger AUC than the N category and TNM stage did. In summary, the proposed LNR category was superior to the conventional N category in predicting the prognosis of ESCC patients.

Authors+Show Affiliations

Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.Department of Thoracic Surgery, The First Hospital of Qinhuangdao, Hebei 066000, China.Department of Cardiopulmonary Function, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.

Pub Type(s)

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

Language

eng

PubMed ID

27941828

Citation

Zhang, Hongdian, et al. "Metastatic Lymph Node Ratio Demonstrates Better Prognostic Stratification Than pN Staging in Patients With Esophageal Squamous Cell Carcinoma After Esophagectomy." Scientific Reports, vol. 6, 2016, p. 38804.
Zhang H, Liang H, Gao Y, et al. Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy. Sci Rep. 2016;6:38804.
Zhang, H., Liang, H., Gao, Y., Shang, X., Gong, L., Ma, Z., Sun, K., Tang, P., & Yu, Z. (2016). Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy. Scientific Reports, 6, 38804. https://doi.org/10.1038/srep38804
Zhang H, et al. Metastatic Lymph Node Ratio Demonstrates Better Prognostic Stratification Than pN Staging in Patients With Esophageal Squamous Cell Carcinoma After Esophagectomy. Sci Rep. 2016 12 12;6:38804. PubMed PMID: 27941828.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy. AU - Zhang,Hongdian, AU - Liang,Huagang, AU - Gao,Yongyin, AU - Shang,Xiaobin, AU - Gong,Lei, AU - Ma,Zhao, AU - Sun,Ke, AU - Tang,Peng, AU - Yu,Zhentao, Y1 - 2016/12/12/ PY - 2016/04/07/received PY - 2016/11/15/accepted PY - 2016/12/13/entrez PY - 2016/12/13/pubmed PY - 2018/7/11/medline SP - 38804 EP - 38804 JF - Scientific reports JO - Sci Rep VL - 6 N2 - This study aimed to evaluate the prognostic significance of lymph node ratio (LNR) by establishing a hypothetical tumor-ratio-metastasis (TRM) staging system in patients with esophageal squamous cell carcinoma (ESCC). The records of 387 ESCC patients receiving curative esophagectomy were retrospectively investigated. The optimal cut-point for LNR was assessed via the best cut-off approach. Potential prognostic parameters were identified through univariate and multivariate analyses. A novel LNR-based TRM stage was proposed. The prognostic discriminatory ability and prediction accuracy of each system were determined using hazard ratio (HR), Akaike information criterion (AIC), concordance index (C-index), and area under the receiver operating characteristic curve (AUC). The optimal cut-points of LNR were set at 0, 0~0.2, 0.2~0.4, and 0.4~1.0. Multivariate Cox analysis indicated that the LNR category was an independent risk factor of overall survival (P < 0.001). The calibration curves for the probability of 3- and 5-year survival showed good consistency between nomogram prediction and actual observation. The LNR category and TRM stage yielded a larger HR, a smaller AIC, a larger C-index, and a larger AUC than the N category and TNM stage did. In summary, the proposed LNR category was superior to the conventional N category in predicting the prognosis of ESCC patients. SN - 2045-2322 UR - https://www.unboundmedicine.com/medline/citation/27941828/Metastatic_lymph_node_ratio_demonstrates_better_prognostic_stratification_than_pN_staging_in_patients_with_esophageal_squamous_cell_carcinoma_after_esophagectomy_ L2 - https://doi.org/10.1038/srep38804 DB - PRIME DP - Unbound Medicine ER -