Clinical Research Papers:
Prognosis of patients with esophageal squamous cell carcinoma after esophagectomy using the log odds of positive lymph nodes
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San-Gang Wu1,*, Jia-Yuan Sun2,*, Li-Chao Yang3,*, Juan Zhou4, Feng-Yan Li2, Qun Li2, Huan-Xin Lin2, Qin Lin1, Zhen-Yu He2
1Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
2Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People’s Republic of China
3Department of Basic Medical Science, Medical College, Xiamen University, Xiamen, People’s Republic of China
4Xiamen Cancer Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
*These authors have contributed equally to this work
Qin Lin, e-mail: firstname.lastname@example.org
Zhen-Yu He, e-mail: email@example.com
Keywords: esophageal squamous cell carcinoma, lymph nodes, log odds of positive lymph nodes, lymph node ratio, prognosis
Received: June 16, 2015 Accepted: September 17, 2015 Published: September 29, 2015
To compare the log odds of positive lymph nodes (LODDS) with the number of positive lymph nodes (pN), lymph node ratio (LNR), removed lymph node (RLN) count, and negative lymph node (NLN) count in determining the prognosis of patients with esophageal squamous cell carcinoma (ESCC) after esophagectomy. The records of patients with ESCC who received esophagectomy were retrospectively reviewed. The log-rank test was used to compare curves for overall survival (OS), and Cox regression analysis was performed to identify prognostic factors. The prognostic performance of the different lymph node staging systems were compared using the linear trend chi-square test, likelihood ratio chi-square test, and Akaike information criterion. A total of 589 patients were enrolled. Univariate Cox analysis showed that pN stage, LNR, RLN count, NLN count, and the LODDS were significantly associated with OS (p < 0.05 for all). Multivariate Cox analysis adjusted for significant factors indicated that LODDS was independent risk factor on overall survival (OS), and a higher LODDS was associated with worse OS (hazard ratio = 3.297, 95% confidence interval: 2.684–4.050, p < 0.001). The modified Tumor-LODDS-Metastasis staging system had better discriminatory ability, monotonicity, and homogeneity, and better optimistic prognostic stratification than the Tumor-Node-Metastasis staging system in determining the prognosis of patients with ESCC. The LODDS staging system was superior to other lymph node classifications in determining the prognosis of patients with ESCC after esophagectomy. LODDS may be incorporated into esophageal staging system if these results are eventually confirmed by other studies.
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