阳性淋巴结对数比值比改善 cT3 食管鳞癌根治性食管切除术后早期复发和生存的风险分层
Log Odds of Positive Lymph Nodes Improves Risk Stratification for Early Recurrence and Survival After Radical Esophagectomy for cT3 Esophageal Squamous Cell Carcinoma.
作者
作者单位
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea. kdjcool@yuhs.ac.
摘要
中文
cT3 食管鳞癌(ESCC)根治性切除术后的早期复发与较差的长期生存密切相关。识别早期复发高危患者可改善术后风险分层并指导个体化随访或辅助治疗。我们回顾性分析了接受 en bloc 食管切除术联合三野淋巴结清扫术的患者。阳性淋巴结对数比值比(LODDS)计算为 log([阳性淋巴结数 + 0.5]/[阴性淋巴结数 + 0.5])。使用最大选择秩统计定义早期复发。采用多因素 Firth 逻辑回归识别早期复发的独立危险因素,然后进行决策树分析以建立分层风险分层。121 例患者中,109 例(90.1%)达到 R0 切除。切除和转移淋巴结中位数分别为 67.0 和 2.0,LODDS 中位数为 -3.46。早期复发定义为术后 16.6 个月内复发。多因素分析显示较高 LODDS、上胸段位置和可切除性状态(可切除或临界可切除)是早期复发的独立预测因素。在互补的基于树的分析中,早期复发风险主要按 LODDS = -2.69 的截断值分层。LODDS > -2.69 患者的 5 年总生存率显著低于 LODDS ≤ -2.69 者(30.0% vs 66.1%, p<0.001)。在 LODDS ≤ -2.69 的患者中,肿瘤位置进一步细化风险分层。LODDS 为 cT3 ESCC 根治性食管切除术后早期复发的术后风险分层提供了一个稳健且临床适用的指标。
English
Early recurrence after curative resection for cT3 esophageal squamous cell carcinoma (ESCC) is strongly associated with poor long-term survival. Identifying patients at high risk of early recurrence may improve postoperative risk stratification and inform tailored surveillance or adjuvant therapy. We retrospectively analyzed patients who underwent en bloc esophagectomy with three-field lymphadenectomy. The log odds of positive lymph nodes (LODDS) were calculated as log([number of positive nodes + 0.5]/[number of negative nodes + 0.5]). Early recurrence was defined using maximally selected rank statistics. Independent risk factors for early recurrence were identified using multivariable Firth logistic regression, followed by decision tree analysis to establish hierarchical risk stratification. Among 121 patients, 109 (90.1%) achieved R0 resection. The median numbers of dissected and metastatic lymph nodes were 67.0 and 2.0, respectively, with a median LODDS of - 3.46. Early recurrence was defined as recurrence within 16.6 months after surgery. Multivariable analysis identified higher LODDS, upper thoracic location, and resectability status (resectable or borderline resectable) as independent predictors of early recurrence. In the complementary tree-based analysis, early recurrence risk was primarily stratified by LODDS using a cut-off of - 2.69. Patients with LODDS > - 2.69 had significantly worse 5-year overall survival than those with LODDS ≤ -2.69 (30.0% versus 66.1%, p < 0.001). Among patients with LODDS ≤ - 2.69, tumor location further refined risk stratification. LODDS provides a robust and clinically applicable metric for postoperative risk stratification of early recurrence in patients undergoing radical esophagectomy for cT3 ESCC.
分类与指标
- 研究类型
- 临床研究
- 病种
- 食管癌
- JCR 分区
- Q1
- 影响因子
- 3.8
- 新锐分区
- 2区