Objective: To evaluate the prognostic value of three different staging schemes based on positive lymph nodes (pN), metastatic lymph nodes ratio (MLR) and log odds of positive lymph nodes (LODDS) in patients with T3 esophageal cancer. Methods: From 2007 to 2014, clinicopathological characteristics of 905 patients who were pathologically diagnosed as T3 esophageal cancer and underwent radical esophagectomy in Zhejiang Cancer Hospital were retrospectively analyzed. Kaplan-Meier curves and Multivariate Cox proportional hazards models were used to evaluate the independent prognostic factors. The values of three lymph node staging schemes for predicting 5-year survival were analyzed by using receiver operating characteristic (ROC) curves. Results: The 1-, 3- and 5-year overall survival rates of patients with T3 esophageal cancer were 80.9%, 50.0% and 38.4%, respectively. Multivariate analysis showed that MLR stage, LODDS stage and differentiation were independent prognostic survival factors (P<0.05 for all). ROC curves showed that the area under the curve of pN stage, MLR stage, LODDS stage was 0.607, 0.613 and 0.618, respectively. However, the differences were not statistically significant (P>0.05). Conclusions: LODDS is an independent prognostic factor for patients with T3 esophageal cancer. The value of LODDS staging system may be superior to pN staging system for evaluating the prognosis of these patients.
目的： 评价以淋巴结转移数目、淋巴结转移率(MLR)和阳性淋巴结对数比(LODDS)为基础的pN分期、MLR分期和LODDS分期预测T3期食管鳞癌患者预后的价值。 方法： 回顾性分析浙江省肿瘤医院2007—2014年905例接受食管癌根治手术、病理确诊为T3期胸段食管鳞癌患者的临床病理资料，采用Kaplan－Meier法和多因素Cox比例风险模型分析患者预后的独立影响因素。采用受试者工作特征(ROC)曲线比较pN、MLR和LODDS分期对患者5年生存预测的价值。 结果： 全组患者术后1、3、5年生存率分别为80.9%、50.0%和38.4%。Cox多因素分析显示，MLR分期、LODDS分期和分化程度是T3期食管癌患者预后的独立影响因素(均P<0.05)。pN分期、MLR分期和LODDS分期预测患者预后所对应的ROC曲线下面积分别为0.607、0.613和0.618，差异无统计学意义(P>0.05)。 结论： LODDS分期是T3期食管癌患者的独立预后因素，LODDS分期对食管癌患者预后的预测价值或优于以pN分期为基础的TNM分期。.
Keywords: Esophageal neoplasms; Lymphatic metastasis; Prognosis.