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Yu W, Xu B, Li P. A novel log odds of positive lymph nodes-based nomogram for predicting overall survival in patients with colorectal signet ring cell carcinoma: a SEER population-based study. Int J Colorectal Dis 2024; 39:44. [PMID: 38558258 PMCID: PMC10984886 DOI: 10.1007/s00384-024-04622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Considering the poor prognosis and high lymph node (LN) involvement rate of colorectal signet ring cell carcinoma (SRCC), this study aimed to construct a prognostic nomogram to predict overall survival (OS) with satisfactory accuracy and utility, based on LN status indicators with superior predictability. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, we obtained cases of colorectal SRCC patients and employed univariate and multivariate Cox analyses to determine independent prognostic factors. Kaplan-Meier curves were utilized to visualize survival differences among these factors. Receiver operating characteristic curves were generated to assess predictive performances of models incorporating various LN status indicators. A novel nomogram, containing optimal LN status indicators and other prognostic factors, was developed to predict OS, whose discriminatory ability and accuracy were evaluated using calibration curves and decision curve analysis. RESULTS A total of 1663 SRCC patients were screened from SEER database. Older patients and those with grades III-IV, tumor sizes > 39 mm, T3/T4 stage, N1/N2 stage, M1 stage, and higher log odds of positive lymph nodes (LODDS) values exhibited poorer prognoses. Age, grade, tumor size, TNM stage, and LODDS were independent prognostic factors. The model containing N stage and LODDS outperformed the one relying solely on N stage as LN status indicator, resulting in a validated nomogram for accurately predicting OS in SRCC patients. CONCLUSION The integration of LODDS, N stage, and other risk factors into a nomogram offered precise OS predictions, enhancing therapeutic decision-making and tailored follow-up management for colorectal SRCC patients.
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Affiliation(s)
- Wenqian Yu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, Chongchuan District, No. 20 Xisi Road, Nantong, 226000, China
- Medical School, Nantong University, Nantong, Jiangsu Province, China
| | - Boqi Xu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Nantong University, Chongchuan District, No. 20 Xisi Road, Nantong, 226000, China.
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Lu RD, Wei ZD, Liu YX, Tian D, Zhang HL, Shang QX, Hu WP, Yang L, Yang YS, Chen LQ. Increased resected lymph node stations improved survival of esophageal squamous cell carcinoma. BMC Cancer 2024; 24:177. [PMID: 38317075 PMCID: PMC10845591 DOI: 10.1186/s12885-024-11886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (nCRT) and surgery have been recommended as the standard treatments for locally advanced esophageal squamous cell carcinoma (ESCC). In addition, nodal metastases decreased in frequency and changed in distribution after neoadjuvant therapy. This study aimed to examine the optimal strategy for lymph node dissection (LND) in patients with ESCC who underwent nCRT. METHODS The hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS) were calculated using the Cox proportional hazard model. To determine the minimal number of LNDs (n-LNS) or least station of LNDs (e-LNS), the Chow test was used. RESULTS In total, 333 patients were included. The estimated cut-off values for e-LNS and n-LNS were 9 and 15, respectively. A higher number of e-LNS was significantly associated with improved OS (HR: 0.90; 95% CI 0.84-0.97, P = 0.0075) and DFS (HR: 0.012; 95% CI: 0.84-0.98, P = 0.0074). The e-LNS was a significant prognostic factor in multivariate analyses. The local recurrence rate of 23.1% in high e-LNS is much lower than the results of low e-LNS (13.3%). Comparable morbidity was found in both the e-LNS and n-LND subgroups. CONCLUSION This cohort study revealed an association between the extent of LND and overall survival, suggesting the therapeutic value of extended lymphadenectomy during esophagectomy. Therefore, more lymph node stations being sampled leads to higher survival rates among patients who receive nCRT, and standard lymphadenectomy of at least 9 stations is strongly recommended.
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Affiliation(s)
- Run-Da Lu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Zheng-Dao Wei
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Yi-Xin Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Han-Lu Zhang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Qi-Xin Shang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Wei-Peng Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Lin Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China.
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, China.
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Song J, Zhang H, Jian J, Chen H, Zhu X, Xie J, Xu X. The Prognostic Significance of Lymph Node Ratio for Esophageal Cancer: A Meta-Analysis. J Surg Res 2023; 292:53-64. [PMID: 37586187 DOI: 10.1016/j.jss.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION This meta-analysis aimed to investigate the prognostic significance of positive lymph node ratio (LNR) in patients with esophageal cancer. MATERIALS AND METHODS The meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a systematic search of relevant literature published until April 2022 in PubMed, EMBASE, and the Cochrane Library. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), with corresponding hazard ratios (HR) and 95% confidence intervals (CI). The included studies were subgrouped based on age, study area, adjuvant therapy, sensitivity analysis, and assessment of publication bias. We analyzed and discussed the results. RESULTS We included 21 studies with 29 cohorts and 11,849 patients. The Newcastle-Ottawa Scale scores of the included studies were no less than six, indicating high research quality. The combined results of HR and 95% CI showed that patients with esophageal cancer with a lower LNR had better OS (HR, 2.58; 95% CI, 2.15-3.11; P < 0.001) and DFS (HR, 3.07; 95% CI, 1.85-5.10; P < 0.001). The subgroup analysis suggested that geographic region, age, and adjuvant therapy affected OS. When any cohort was excluded, no significant changes were observed in the pooled HR of the OS group, indicating reliable and robust results. Egger's and Begg's tests showed no potential publication bias in the studies that used OS as an outcome measurement index, indicating reliable results. Sensitivity analyses and assessments of publication bias (<10) were not performed because of an insufficient number of DFS studies. CONCLUSION Patients with a lower positive LNR had a higher survival rate, suggesting that positive LNR may be a promising predictor of EC prognosis in esophageal cancer. After radical resection of esophageal cancer, the ratio of the number of dissected lymph nodes to the number of positive lymph nodes in patients with esophageal cancer should be considered to accurately evaluate the prognosis.
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Affiliation(s)
- Jiannan Song
- Department of Thoracic Surgery, Anhui Chest Hospital, Thoracic Clinical College of Anhui Medical University, Hefei, Anhui, China
| | - Heng Zhang
- Department of Thoracic Surgery, Anhui Chest Hospital, Thoracic Clinical College of Anhui Medical University, Hefei, Anhui, China
| | - Junling Jian
- Department of Thoracic Surgery, Anhui Chest Hospital, Thoracic Clinical College of Anhui Medical University, Hefei, Anhui, China
| | - Hai Chen
- Department of Thoracic Surgery, Anhui Chest Hospital, Thoracic Clinical College of Anhui Medical University, Hefei, Anhui, China
| | - Xiaodong Zhu
- Department of Thoracic Surgery, Anhui Chest Hospital, Thoracic Clinical College of Anhui Medical University, Hefei, Anhui, China
| | - Jianfeng Xie
- Department of Thoracic Surgery, Anhui Chest Hospital, Thoracic Clinical College of Anhui Medical University, Hefei, Anhui, China
| | - Xianquan Xu
- Department of Thoracic Surgery, Anhui Chest Hospital, Thoracic Clinical College of Anhui Medical University, Hefei, Anhui, China.
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Zhao Z, Wang H, Liu Y, Li M, Li M. Abdominal lymph node metastasis in non-surgical esophageal squamous cell carcinoma: prognostic significance and a novel staging strategy. Front Oncol 2023; 13:1234426. [PMID: 37876971 PMCID: PMC10591313 DOI: 10.3389/fonc.2023.1234426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/21/2023] [Indexed: 10/26/2023] Open
Abstract
Purpose This study aimed to evaluate the feasibility of a combination of abdominal lymph node (LN) metastasis and the number of LNs in esophageal squamous cell carcinoma (ESCC) patients to optimize its clinical nodal staging. Methods A retrospective study, including a total of 707 ESCC patients treated with definitive radiotherapy, was conducted at two participating institutes. Different combinations of LN variables, including abdominal LN metastasis (R1: no-abdominal LN metastasis; R2: abdominal LN metastasis), were further analyzed to propose a potential revised nodal (rN) staging. Results The multivariate analyses showed that the number of metastatic LN and abdominal LN metastasis were independent prognostic factors for the overall survival (OS). The results showed no significant differences in the OS between the N2 patients with abdominal LN metastasis and N3 patients. The OS of the stage III patients with abdominal LN metastasis was not significantly different from those with stage IVa. The N3R1 and N1-2R2 had similar hazard ratios (HRs). The N1R1 subset was defined as rN1, the N2R1 subset was defined as rN2, and the N3R1-2 and N1-2R2 subsets were defined as rN3. The HRs of OS of the rN2 and rN3 groups increased subsequently. The rN stage could identify the differences in the OS times of each subgroup based on the 8th AJCC cN staging or the 11th JES N staging. Conclusions The rN staging, including the number of metastatic LNs and abdominal LN metastasis, might serve as a potential prognostic predictor for non-surgical patients with ESCC.
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Affiliation(s)
- Zongxing Zhao
- Department of Radiation Oncology, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
| | - Hongmin Wang
- Joint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
| | - Yajing Liu
- Clinical Laboratory, Liaocheng Third People’s Hospital, Liaocheng, Shandong, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Mingjun Li
- Department of Radiation Oncology, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
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Bolger JC, Castro PP, Marwah A, Tavakoli I, Espin-Garcia O, Darling GE, Yeung JC. Nodal Yield <15 Is Associated With Reduced Survival in Esophagectomy and Is a Quality Metric. Ann Thorac Surg 2023; 116:130-136. [PMID: 36918078 DOI: 10.1016/j.athoracsur.2023.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Surgical resection after neoadjuvant therapy remains the cornerstone of curative management of esophageal adenocarcinoma and is frequently used for squamous cell carcinoma. The optimal extent of lymphadenectomy and whether increasing lymph node yields confer a survival benefit remains unclear. Guidelines suggest resecting and examining a minimum of 15 lymph nodes at esophagectomy. This study assessed the impact of lymph node yield and lymph node ratio (LNR) on survival, identifying factors influencing nodal yield and radicality of resection. METHODS All patients undergoing esophagectomy with curative intent at a single institution (stage 1-4 inclusive) from January 1, 2010, to December 31, 2020, were reviewed. Clinical and pathologic variables were interrogated. LNR was calculated by dividing positive lymph nodes by the total nodes resected. RESULTS Esophagectomy was performed in 397 patients, with 288 undergoing minimally invasive esophagectomy (MIE). Margin status (hazard ratio [HR], 1.80; 95% CI, 1.15-2.83; P < .01), nodal yield <15 (HR, 1.98; 95% CI, 1.29-3.04; P = .002), and elevated LNR (HR, 8.16; 95% CI, 2.89-23.06; P < .001) predicted survival. MIE had higher nodal yields compared with open procedures (30.7 vs 25.3, P < .001). Patients undergoing neoadjuvant chemoradiotherapy had lower nodal yields compared with those with no neoadjuvant therapy and those with neoadjuvant chemotherapy (26.4 vs 30.6 vs 36.8, respectively; P < .001). Regression analysis determined a LNR of <0.05 was associated with a survival benefit. CONCLUSIONS Textbook lymphadenectomy is associated with improved survival. Low lymph node yield and a high LNR are associated with reduced overall survival. A LNR of <0.05 is associated with significant survival benefit. A minimum nodal yield of 15 should remain the standard of care.
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Affiliation(s)
- Jarlath C Bolger
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Pablo Perez Castro
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Anindita Marwah
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Iran Tavakoli
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Osvaldo Espin-Garcia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Yeung
- Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
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Guo P, Wang X, Xia L, Shawureding N, Hu Z. Analysis of factors associated with the prognosis of papillary thyroid cancer and the construction of a survival model. Cancer Med 2022; 12:7868-7876. [PMID: 36560883 PMCID: PMC10134317 DOI: 10.1002/cam4.5555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the survival prediction value of lymph node ratio (LNR) and preoperative thyroglobulin (Tg) in the prognosis of thyroid papillary carcinoma (PTC). METHODS A total of 495 patients with PTC and lymph node metastasis treated at the Cancer Hospital of Xinjiang Medical University were selected for a retrospective study. The disease-free survival (DFS) of patients was the follow-up endpoint. DFS was calculated for all patients. The Cox proportional risk regression model and nomogram were used to predict the survival prognosis of PTC with lymph node metastasis by index. LNR and preoperative Tg level cutoff values were obtained using ROC curves. To express DFS, Kaplan-Meier survival curves were created. Using 3- and 5-year calibration curves and AUC values, the prognostic models' precision and discrimination were assessed. Clinical decision curve analysis was used to forecast clinical benefitability. Finally, the results were validated using internal cross-validation. RESULTS The cutoff values of LNR and preoperative Tg level were 0.295 and 50.24, respectively, and they were divided into two groups according to the cutoff values. Multifactorial Cox regression models showed that NLNM, LNR, and preoperative Tg level (all p < 0.05) were independent risk factors affecting the prognosis of PTC with lymph node metastasis. Kaplan-Meier curves showed higher DFS rates in the group with low NLNM (<10), LNR (<0.295), and preoperative Tg level (<50.24) groups. The 3-year and 5-year calibration curves showed good agreement. A ROC curve analysis was performed on the nomogram model, and its AUC values at 3 and 5 years were, respectively, 0.805 and 0.793. Clinical decision curves indicate good clinical benefit. Finally, internal cross-validation demonstrated the legitimacy of the prognostic model. CONCLUSION The LNR and preoperative Tg levels, in combination with other independent factors, were effective in predicting the survival prognosis for patients with PTC.
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Affiliation(s)
- Peng Guo
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Xinhua Wang
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Luhua Xia
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Nadiremu Shawureding
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Zhiheng Hu
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
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Kano K, Yamada T, Ogata T, Oshima T. ASO Author Reflections: Lymph Node Ratio After Neoadjuvant Chemotherapy in Locally Advanced Esophageal Cancer. Ann Surg Oncol 2021; 28:8473. [PMID: 34196860 DOI: 10.1245/s10434-021-10394-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Kazuki Kano
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
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