Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery

BackgroundThe metastatic status of regional lymph nodes is an effective risk factor for the prognosis of distal cholangiocarcinoma (dCCA). But existing lymph node staging is not accurate enough and is susceptible to interference. This study aims to explore the predictive ability of the log odds of p...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Xiuyi Huang, Xiaoya Niu, Zhen You, Youlin Long, Fan Luo, Hui Ye
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	distal cholangiocarcinoma (dCCA) log odds of positive lymph node (LODDS) lymph node stage prognosis ability modeling Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/fde30f60950740209c95fda7acc41ad0
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:fde30f60950740209c95fda7acc41ad0
record_format	dspace
spelling	oai:doaj.org-article:fde30f60950740209c95fda7acc41ad02021-12-03T07:16:02ZComparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery2234-943X10.3389/fonc.2021.779761https://doaj.org/article/fde30f60950740209c95fda7acc41ad02021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.779761/fullhttps://doaj.org/toc/2234-943XBackgroundThe metastatic status of regional lymph nodes is an effective risk factor for the prognosis of distal cholangiocarcinoma (dCCA). But existing lymph node staging is not accurate enough and is susceptible to interference. This study aims to explore the predictive ability of the log odds of positive lymph nodes (LODDS) staging system of dCCA compared with existing lymph node staging systems.MethodsA total of 928 dCCA patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database as the training cohort, and 207 dCCA patients from West China Hospital who underwent surgery were reviewed as the validation cohort. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression were conducted to identify the most meaningful factors relevant to prognosis. The performance of four lymph node stage systems was compared by a model-based approach.ResultAge at diagnosis, pathological grade, American Joint Committee on Cancer (AJCC) tumor 7th T stage, tumor size, radiotherapy, chemotherapy, and lymph node stage system were independent prognostic factors. The model with the LODDS system had a better model fit with the highest C-index (0.679) and 1-/3-/5- area under the receiver operating characteristic curve (AUC) (0.739/0.671/0.658) as well as the lowest Akaike information criterion (AIC) (5,020.52). External validation results from 207 dCCA patients showed a C-index of 0.647 and 1-/3-/5-AUC of 0.740/0.683/0.589. Compared with the lymph node ratio (LNR), AJCC 8th N system, and 7th N system, the 5-year net reclassification improvement (NRI) of the LODDS system was 0.030 (95% CI: −0.079 to 0.147), 0.042 (95% CI: −0.062 to 0.139), and 0.040 (95% CI: −0.057 to 0.146), respectively. The integrated discrimination improvement (IDI) of LODDS improved compared with the LNR model (0.016; 95% CI: −0.001 to 0.036), AJCC 8th N system (0.020; 95% CI: 0.003–0.037), and AJCC 7th N system (0.019; 95% CI: 0.002–0.036). Decision curve analysis (DCA) also shows a greater net benefit of LODDS. In lymph node-negative patients, LODDS reveals a positive linear relationship with the hazard ratio (HR). The stage capacity of LODDS in a subgroup analysis stratified by examined lymph node number (ELNN) was consistent.ConclusionsThe LODDS lymph node stage system has superior predictive performance as compared with the LNR, AJCC 7th, and 8th lymph node stage systems. Meanwhile, LODDS has a more detailed staging ability and good stability.Xiuyi HuangXiaoya NiuZhen YouYoulin LongFan LuoHui YeFrontiers Media S.A.articledistal cholangiocarcinoma (dCCA)log odds of positive lymph node (LODDS)lymph node stageprognosis abilitymodelingNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	distal cholangiocarcinoma (dCCA) log odds of positive lymph node (LODDS) lymph node stage prognosis ability modeling Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	distal cholangiocarcinoma (dCCA) log odds of positive lymph node (LODDS) lymph node stage prognosis ability modeling Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Xiuyi Huang Xiaoya Niu Zhen You Youlin Long Fan Luo Hui Ye Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery
description	BackgroundThe metastatic status of regional lymph nodes is an effective risk factor for the prognosis of distal cholangiocarcinoma (dCCA). But existing lymph node staging is not accurate enough and is susceptible to interference. This study aims to explore the predictive ability of the log odds of positive lymph nodes (LODDS) staging system of dCCA compared with existing lymph node staging systems.MethodsA total of 928 dCCA patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database as the training cohort, and 207 dCCA patients from West China Hospital who underwent surgery were reviewed as the validation cohort. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression were conducted to identify the most meaningful factors relevant to prognosis. The performance of four lymph node stage systems was compared by a model-based approach.ResultAge at diagnosis, pathological grade, American Joint Committee on Cancer (AJCC) tumor 7th T stage, tumor size, radiotherapy, chemotherapy, and lymph node stage system were independent prognostic factors. The model with the LODDS system had a better model fit with the highest C-index (0.679) and 1-/3-/5- area under the receiver operating characteristic curve (AUC) (0.739/0.671/0.658) as well as the lowest Akaike information criterion (AIC) (5,020.52). External validation results from 207 dCCA patients showed a C-index of 0.647 and 1-/3-/5-AUC of 0.740/0.683/0.589. Compared with the lymph node ratio (LNR), AJCC 8th N system, and 7th N system, the 5-year net reclassification improvement (NRI) of the LODDS system was 0.030 (95% CI: −0.079 to 0.147), 0.042 (95% CI: −0.062 to 0.139), and 0.040 (95% CI: −0.057 to 0.146), respectively. The integrated discrimination improvement (IDI) of LODDS improved compared with the LNR model (0.016; 95% CI: −0.001 to 0.036), AJCC 8th N system (0.020; 95% CI: 0.003–0.037), and AJCC 7th N system (0.019; 95% CI: 0.002–0.036). Decision curve analysis (DCA) also shows a greater net benefit of LODDS. In lymph node-negative patients, LODDS reveals a positive linear relationship with the hazard ratio (HR). The stage capacity of LODDS in a subgroup analysis stratified by examined lymph node number (ELNN) was consistent.ConclusionsThe LODDS lymph node stage system has superior predictive performance as compared with the LNR, AJCC 7th, and 8th lymph node stage systems. Meanwhile, LODDS has a more detailed staging ability and good stability.
format	article
author	Xiuyi Huang Xiaoya Niu Zhen You Youlin Long Fan Luo Hui Ye
author_facet	Xiuyi Huang Xiaoya Niu Zhen You Youlin Long Fan Luo Hui Ye
author_sort	Xiuyi Huang
title	Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery
title_short	Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery
title_full	Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery
title_fullStr	Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery
title_full_unstemmed	Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery
title_sort	comparison of four lymph node stage methods for predicting the prognosis of distal cholangiocarcinoma patients after surgery
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/fde30f60950740209c95fda7acc41ad0
work_keys_str_mv	AT xiuyihuang comparisonoffourlymphnodestagemethodsforpredictingtheprognosisofdistalcholangiocarcinomapatientsaftersurgery AT xiaoyaniu comparisonoffourlymphnodestagemethodsforpredictingtheprognosisofdistalcholangiocarcinomapatientsaftersurgery AT zhenyou comparisonoffourlymphnodestagemethodsforpredictingtheprognosisofdistalcholangiocarcinomapatientsaftersurgery AT youlinlong comparisonoffourlymphnodestagemethodsforpredictingtheprognosisofdistalcholangiocarcinomapatientsaftersurgery AT fanluo comparisonoffourlymphnodestagemethodsforpredictingtheprognosisofdistalcholangiocarcinomapatientsaftersurgery AT huiye comparisonoffourlymphnodestagemethodsforpredictingtheprognosisofdistalcholangiocarcinomapatientsaftersurgery
_version_	1718373850265157632

Comparison of Four Lymph Node Stage Methods for Predicting the Prognosis of Distal Cholangiocarcinoma Patients After Surgery

Ejemplares similares