Clinical Research Papers:

Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection

Hongdian Zhang, Xiaobin Shang, Chuangui Chen, Yongyin Gao, Xiangming Xiao, Peng Tang, Xiaofeng Duan, Mingjian Yang, Hongjing Jiang and Zhentao Yu _

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Oncotarget. 2016; 7:74337-74349. https://doi.org/10.18632/oncotarget.11188

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Hongdian Zhang1,*, Xiaobin Shang1,*, Chuangui Chen1, Yongyin Gao2, Xiangming Xiao3, Peng Tang1, Xiaofeng Duan1, Mingjian Yang1, Hongjing Jiang1 and Zhentao Yu1

1 Department of Esophageal Cancer, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China

2 Department of Cardiopulmonary Function, Tianjin Medical University, Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin, China

3 Department of General Surgery, Weifang People’s Hospital, Shandong, China

* These authors have contributed equally to this work

Correspondence to:

Zhentao Yu, email:

Keywords: adenocarcinoma of the esophagogastric junction; lymph node metastasis; metastatic lymph node ratio; tumor-N-ratio-metastasis (TrNM) staging system; prognosis

Received: March 14, 2016 Accepted: July 27, 2016 Published: August 10, 2016


This study aimed to assess the prognostic value of the hypothetical tumor-N-ratio (rN)-metastasis (TrNM) staging system in adenocarcinoma of the esophagogastric junction (AEG). The clinical data of 387 AEG patients who received surgical resection were retrospectively reviewed. The optimal cut-off point of rN was calculated by the best cut-off approach using log-rank test. Kaplan-Meier plots and Cox regressions model were applied for univariate and multivariate survival analyses. A TrNM staging system based on rN was proposed. The discriminating ability of each staging was evaluated by using an adjusted hazard ratio (HR) and a −2log likelihood. The prediction accuracy of the model was assessed by using the area under the curve (AUC) and the Harrell’s C-index. The number of examined lymph nodes (LNs) was correlated with metastatic LNs (r = 0.322, P < 0.001) but not with rN (r = 0.098, P > 0.05). The optimal cut-points of rN were calculated as 0, 0~0.3, 0.3~0.6, and 0.6~1.0. Univariate analysis revealed that pN and rN classifications significantly influenced patients’ RFS and OS (P < 0.001). Multivariate analysis adjusted for significant factors revealed that rN was recognized as an independent risk factor. A larger HR, a smaller −2log likelihood and a larger prediction accuracy were obtained for rN and the modified TrNM staging system. Taken together, our study demonstrates that the proposed N-ratio-based TrNM staging system is more reliable than the TNM staging system in evaluating prognosis of AEG patients after curative resection.

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