优化淋巴结比率预测淋巴结转移阳性胃癌患者预后研究
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南京医科大学第一附属医院普外科 江苏 南京

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国家自然科学基金项目(82373335)


Prediction of prognosis in patients with node-positive gastric cancer by modified lymph node ratio
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Department of General Surgery, the First Affiliated Hospital with Nanjing Medical University

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The National Natural Science Foundation of China (82373335)

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    摘要:

    目的:将淋巴结比率(lymph node ratio, LNR)与中心淋巴结(central lymph nodes, CnLNs)转移结合,构建优化淋巴结比率(modified lymph node ratio, mLNR),并探究该指标对胃癌患者预后影响。方法:卡方分析对比CnLNs有无转移两组胃癌患者组间差异,Cox回归分析影响胃癌患者生存的因素,构建受试者工作特征(receiver operating characteristic, ROC)曲线以确定LNR高低分类截断值,绘制Kaplan-Meier曲线可视化分析胃癌患者生存情况,构建列线图以预测胃癌患者生存预后。结果:CnLNs有无转移两组患者间胃切除方式(P =0.042),肿瘤大小(P =0.043),分化程度(P =0.001),脉管侵犯(P <0.001),神经侵犯(P <0.001),T分期(P =0.001),N分期(P <0.001),癌胚抗原(carcinoembryonic antigen, CEA)(P =0.002)及糖类抗原199(carbohydrate antigen199, CA199)(P =0.026)高低在两组间有显著差异;LNR及CnLNs均能很好区分胃癌患者生存情况,但LNR的区分效力显著强于CnLNs。此外mLNR能够很好的预测胃癌患者生存,是影响胃癌患者生存的独立危险因素。结论:利用CnLNs构建的mLNR是影响胃癌患者生存的独立危险因素,有望作为胃癌患者预后判别的新指标。

    Abstract:

    Objective: To combine lymph node ratio (LNR) with central lymph node metastasis (CnLNs) to construct modified lymph node ratio (mLNR), and then investigated the impact mLNR had on prognosis of patients with gastric cancer. Methods: Chi-square analysis was performed to analyze the differences between groups of CnLNs- and CnLNs+ gastric cancer patients, Cox regression analysis was performed to analyze the factors affecting the survival of gastric cancer patients, receiver operating characteristic (ROC) curve was constructed to determine the cut-off value of LNR classification, Kaplan-Meier curve was drawn to visually analyze the survival of gastric cancer patients, and nomogram was constructed to predict the survival and prognosis of gastric cancer patients. Results: Way of gastrectomy (P =0.042), tumor size (P =0.043), degree of differentiation (P =0.001), vascular invasion (P <0.001), neural invasion (P <0.001), T stage (P =0.001) and N stage (P <0.001), CEA (P =0.002) and CA199 (P =0.026) were significantly different between the two groups. Both LNR and CnLNs were able to distinguish the survival of gastric cancer patients, but LNR seemed more effective than CnLNs. In addition, mLNR could well predict the survival of patients with gastric cancer and was an independent risk factor affecting the survival of patients with gastric cancer. Conclusion: Utilizing CnLNs to construct mLNR was an independent risk factor for the survival of gastric cancer patients and was expected to be a novel prognostic indicator for patients with gastric cancer.

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  • 收稿日期:2024-11-29
  • 最后修改日期:2025-02-28
  • 录用日期:2025-04-29
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