中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
10期
1057-1061
,共5页
王积楠%王利%马金国%刘维维%戴冬秋
王積楠%王利%馬金國%劉維維%戴鼕鞦
왕적남%왕리%마금국%류유유%대동추
结肠肿瘤%淋巴结分期%淋巴结比率%预后
結腸腫瘤%淋巴結分期%淋巴結比率%預後
결장종류%림파결분기%림파결비솔%예후
Colonic neoplasms%Lymph node stage%Lymph node ratio%Prognosis
目的 比较Ⅲ期结肠癌患者不同区域淋巴结分级系统的临床应用价值,建立其预后预测模型.方法 回顾性分析1999年1月至2008年12月间在中国医科大学肿瘤研究所行根治性手术的256例Ⅲ期结肠癌患者的临床和随访资料.根据与区域淋巴结转移相关的各项指标,分别使用AJCC第7版中的pN分期、日本大肠癌临床处理规约(JGR)中的jN分期及基于Log-rank统计学计算得出的淋巴结比率(LNR)分期对纳入研究的患者进行淋巴结(N)分期.使用线性趋势x2检验、似然比x2检验和一致性指数评估各分期系统的同质性、单调性和判别力.应用单因素分析和多因素预后分析建立相关的预后预测模型,通过比较各模型AIC值得出最理想的预后预测模型.结果 通过Log-rank检验对每个分割点进行检验,求得最优分割点为0.11和0.39,以其作为分割点进行LNR分期,分为LNR1(LNR小于0.11)、LNR2(0.11～0.39)和LNR3(大于或等于0.39).经一致性检验,pN分期、jN分期及LNR分期的一致性指数分别为0.624、0.611和0.700,三者比较,LNR分期系统的异质性最小.通过Cox模型分别针对pN分期、jN分期及LNR分期建立预后预测模型,其AIC值分别为99.937、71.631和65.548,三者比较,LNR分期的模型预后价值最高.结论 LNR分期(0.11和0.39为截点)对于Ⅲ期结肠癌患者而言,是最为理想的分期系统,其对患者预后的评估价值优于现行的最新版AJCC的pN分期及JGR的jN分期.
目的 比較Ⅲ期結腸癌患者不同區域淋巴結分級繫統的臨床應用價值,建立其預後預測模型.方法 迴顧性分析1999年1月至2008年12月間在中國醫科大學腫瘤研究所行根治性手術的256例Ⅲ期結腸癌患者的臨床和隨訪資料.根據與區域淋巴結轉移相關的各項指標,分彆使用AJCC第7版中的pN分期、日本大腸癌臨床處理規約(JGR)中的jN分期及基于Log-rank統計學計算得齣的淋巴結比率(LNR)分期對納入研究的患者進行淋巴結(N)分期.使用線性趨勢x2檢驗、似然比x2檢驗和一緻性指數評估各分期繫統的同質性、單調性和判彆力.應用單因素分析和多因素預後分析建立相關的預後預測模型,通過比較各模型AIC值得齣最理想的預後預測模型.結果 通過Log-rank檢驗對每箇分割點進行檢驗,求得最優分割點為0.11和0.39,以其作為分割點進行LNR分期,分為LNR1(LNR小于0.11)、LNR2(0.11～0.39)和LNR3(大于或等于0.39).經一緻性檢驗,pN分期、jN分期及LNR分期的一緻性指數分彆為0.624、0.611和0.700,三者比較,LNR分期繫統的異質性最小.通過Cox模型分彆針對pN分期、jN分期及LNR分期建立預後預測模型,其AIC值分彆為99.937、71.631和65.548,三者比較,LNR分期的模型預後價值最高.結論 LNR分期(0.11和0.39為截點)對于Ⅲ期結腸癌患者而言,是最為理想的分期繫統,其對患者預後的評估價值優于現行的最新版AJCC的pN分期及JGR的jN分期.
목적 비교Ⅲ기결장암환자불동구역림파결분급계통적림상응용개치,건립기예후예측모형.방법 회고성분석1999년1월지2008년12월간재중국의과대학종류연구소행근치성수술적256례Ⅲ기결장암환자적림상화수방자료.근거여구역림파결전이상관적각항지표,분별사용AJCC제7판중적pN분기、일본대장암림상처리규약(JGR)중적jN분기급기우Log-rank통계학계산득출적림파결비솔(LNR)분기대납입연구적환자진행림파결(N)분기.사용선성추세x2검험、사연비x2검험화일치성지수평고각분기계통적동질성、단조성화판별력.응용단인소분석화다인소예후분석건립상관적예후예측모형,통과비교각모형AIC치득출최이상적예후예측모형.결과 통과Log-rank검험대매개분할점진행검험,구득최우분할점위0.11화0.39,이기작위분할점진행LNR분기,분위LNR1(LNR소우0.11)、LNR2(0.11～0.39)화LNR3(대우혹등우0.39).경일치성검험,pN분기、jN분기급LNR분기적일치성지수분별위0.624、0.611화0.700,삼자비교,LNR분기계통적이질성최소.통과Cox모형분별침대pN분기、jN분기급LNR분기건립예후예측모형,기AIC치분별위99.937、71.631화65.548,삼자비교,LNR분기적모형예후개치최고.결론 LNR분기(0.11화0.39위절점)대우Ⅲ기결장암환자이언,시최위이상적분기계통,기대환자예후적평고개치우우현행적최신판AJCC적pN분기급JGR적jN분기.
Objective To evaluate the clinical value of different regional lymph node staging system and to establish a predictive prognostic model for stage Ⅲ colon cancer.Methods A total of 256 Patients with stage Ⅲ colon cancer from January 1999 to December 2008 were identified from the China Medical University Cancer and underwent radical surgery.Based on information on regional lymph nodes,lymph nodes were staged LNR staging using pN stage in the 7th edition of the AJCC,the jN stage of the JGR,and LNR-stage on the basis of Log-rank statistics,resepectively.Using the linear trend chi-square test,likelihood ratio Chi-square test,concordant index (c-index) to evaluate the homogeneity,monotonicity,and discrimination power of the staging system.Univariate and multivariate analyses were used to determine the clinical and pathological prognostic impact factors.After relevant diagnostic models were established,the Akaike Information Criterion (AIC) value was calculated to compare and identify the best diagnostic model.Results Log-rank statistics found that 0.11 and 0.39 were the optimal cut-off point.LNR staging system included LNR1 (LNR＜0.11 ),LNR2 (0.11,0.39),and LNR3 (0.39,1).The concordance indices were 0.624 for pN,0.611 for jN,and 0.700 for LNR.The heterogeneity was the lowest for LNR.Cox regression model was used to establish prognostic models for pN,jN,and LNR,and the AIC was 99.937,71.631,and 65.548,respectively.The prognostic value was the highest for LNR.Conclusion LNR staging is the ideal staging system for stage Ⅲ colon cancer patients,which is better than the latest version of the current AJCC pN stage and JGR jN staging.
