Prognostic Nomograms Based on Three Lymph Node Classification Systems for Resected Gastric Adenocarcinoma: A Large
Keying Che1, Yue Wang1, Nandie Wu1
1The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China.
Annals of Surgical Oncology
|July 9, 2021
Summary
The log odds of metastatic lymph nodes (LODDS) system offers superior prognostic accuracy for resected gastric adenocarcinoma (GAC) compared to AJCC N stage and lymph node ratio (LNR). This classification aids in differentiating risk subgroups and guiding treatment decisions.
Area of Science:
- Oncology
- Surgical Pathology
- Biostatistics
Background:
- Optimal lymph node classification for gastric adenocarcinoma (GAC) prognosis is unclear.
- Existing systems like AJCC N stage may lack precision in risk stratification.
- Need for improved prognostic tools for resected GAC patients.
Purpose of the Study:
- Compare prognostic nomograms based on AJCC N stage, lymph node ratio (LNR), and log odds of metastatic lymph nodes (LODDS).
- Evaluate the ability of these systems to differentiate risk subgroups in resected GAC.
- Identify the most reliable lymph node classification for clinical prognostic assessment.
Main Methods:
- Utilized data from 4633 patients with resected stage I-III GAC (SEER database, 2004-2015).
- Constructed nomograms based on Cox regression analyses for prognostic factors.
- Performed external validation and Kaplan-Meier survival analysis for postoperative radiotherapy (PORT) effects.
Main Results:
- Age, grade, primary site, T stage, N stage, LNR, LODDS, and radiotherapy were independent predictors.
- The LODDS nomogram demonstrated superior discrimination and calibration.
- LODDS classification more accurately differentiated risk subgroups and improved prognostic discrimination.
Conclusions:
- LODDS is the most reliable lymph node classification for predicting resected GAC prognosis.
- Recommended for clinical prognostic assessment and guiding radiotherapy decisions.
- Incorporating LODDS into staging systems enhances prognostic accuracy and treatment guidance.
