Lymph node ratio is a superior predictor in surgically treated early-onset pancreatic cancer

Yangyang Zheng; Zhenhua Lu; Xiaolei Shi; Tianhua Tan; Cheng Xing; Jingyong Xu; Hongyuan Cui; Jinghai Song

doi:10.3389/fonc.2022.975846

Lymph node ratio is a superior predictor in surgically treated early-onset pancreatic cancer

Front Oncol. 2022 Sep 2:12:975846. doi: 10.3389/fonc.2022.975846. eCollection 2022.

Authors

Yangyang Zheng^{1

2}, Zhenhua Lu¹, Xiaolei Shi¹, Tianhua Tan^{1

2}, Cheng Xing¹, Jingyong Xu¹, Hongyuan Cui¹, Jinghai Song^{1

2}

Affiliations

¹ Department of General Surgery, Department of Hepato-bilio-pancreatic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
² Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

Background: The prognostic performance of four lymph node classifications, the 8th American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) N stage, lymph node ratio (LNR), log odds of positive lymph nodes (LODDS), and examined lymph nodes (ELN) in early-onset pancreatic cancer (EOPC) remains unclear.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database was searched for patients with EOPC from 2004 to 2016. 1048 patients were randomly divided into training (n = 733) and validation sets (n = 315). The predictive abilities of the four lymph node staging systems were compared using the Akaike information criteria (AIC), receiver operating characteristic area under the curve (AUC), and C-index. Multivariate Cox analysis was performed to identify independent risk factors. A nomogram based on lymph node classification with the strongest predictive ability was established. The nomogram's precision was verified by the C-index, calibration curves, and AUC. Kaplan-Meier analysis and log-rank tests were used to compare differences in survival at each stage of the nomogram.

Results: Compared with the 8th N stage, LODDS, and ELN, LNR had the highest C-index and AUC and the lowest AIC. Multivariate analysis showed that N stage, LODDS, LNR were independent risk factors associated with cancer specific survival (CSS), but not ELN. In the training set, the AUC values for the 1-, 3-, and 5-year CSS of the nomogram were 0.663, 0.728, and 0.760, respectively and similar results were observed in the validation set. In addition, Kaplan-Meier survival analysis showed that the nomogram was also an important factor in the risk stratification of EOPC.

Conclusion: We analyzed the predictive power of the four lymph node staging systems and found that LNR had the strongest predictive ability. Furthermore, the novel nomogram prognostic staging mode based on LNR was also an important factor in the risk stratification of EOPC.

Keywords: early-onset pancreatic cancer; examined lymph nodes; log odds of positive lymph nodes; lymph node ratio; nomogram.