河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (12): 1417-1422.doi: 10.3969/j.issn.1007-3205.2022.12.010

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探讨淋巴结阳性率对上尿路上皮癌的预后价值

  

  1. 南京医科大学附属淮安第一医院泌尿外科，江苏  淮安 223300

  • 出版日期:2022-12-25 发布日期:2023-01-11
  • 作者简介:赵伦（1992-)，男，江苏宿迁人，南京医科大学附属淮安第一医院医师，医学硕士，从事泌尿外科肿瘤诊治研究。
  • 基金资助:
    江苏省博士后科研资助计划（1701060B）

Prognostic value of positive lymph node ratio in upper tract urothelial carcinoma

  1. Department of Urology, the First People′s Hospital of Huai′an City Affiliated to Nanjing Medical University, Jiangsu Province, Huai′an 223300, China
  • Online:2022-12-25 Published:2023-01-11

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摘要： 目的 探讨淋巴结阳性率(positive lymph node ratio，LNR)对上尿路上皮癌（upper tract urothelial carcinoma，UTUC)患者的预后价值。
方法 从SEER数据库中选取188例符合纳入标准的UTUC患者，用X-tile软件选取LNR的最佳截断点，运用Kaplan-Meier法计算UTUC患者的3年总体生存率(overall survival，OS)和3年肿瘤特异生存率(cancer-specific survival，CSS)，同时运用COX比例风险回归模型分析LNR在UTUC患者预后方面的预测价值，最后，计算ROC曲线下面积以及绘制校准曲线用于比较LNR与传统N分期的预测性能。
结果 经X-tile 软件筛选，LNR的最佳截断点为0.6 (LNR＜0.6 vs. LNR≥0.6)。单因素COX回归分析和多因素COX回归分析，肿瘤分期、远处转移、肿瘤大小是影响UTUC3年OS的独立危险因素（P＜0.05）；同时，LNR、远处转移、肿瘤大小是3年CSS的独立危险因素（P＜0.05）。较LNR≥0.6组，LNR＜0.6组UTUC的预后明显更优（P＜0.05）。同时，通过计算ROC曲线下面积，比较LNR和N分期评估患者预后的准确性。LNR(LNR＜0.6，LNR≥0.6)在评估3年OS与3年CSS的价值方面明显优于传统的N分期(P＜0.05)。
结论 LNR≥0.6是UTUC患者3年CSS的独立预后危险因素，而且LNR的预后评估价值明显优于传统N分期。  


关键词: 泌尿系肿瘤, 淋巴结阳性率, SEER数据库

Abstract: Objective To investigate the prognostic value of positive lymph node ratio (LNR) in patients with upper tract urothelial carcinoma (UTUC). 
Methods A total of 188 UTUC patients who met inclusion criteria were selected from SEER database. X-tile software was used to select the optimal cut-off point of LNR. Kaplan-meier method was used to calculate 3-year overall survival (OS) and 3-year cancer-specific survival (CSS) of UTUC patients, and COX proportional hazard models was used to analyze the prognostic value of LNR in patients with UTUC. Finally, the area under the receiver operating characteristic (ROC) curve was calculated and the calibration curve was drawn to compare the predictive performance of LNR with traditional N staging. 
Results The optimal cut-off point of LNR was 0.6 (LNR ＜ 0.6 vs. LNR≥0.6) after X-tile software screening. Univariate and multivariate COX regression analyses showed that tumor stage, distant metastasis and tumor size were independent risk factors affecting the 3-year OS of UTUC (P＜0.05), and LNR, distant metastasis and tumor size were independent risk factors for 3-year CSS (P＜0.05). The prognosis of UTUC in LNR＜0.6 group was significantly better than that in LNR ≥ 0.6 group (P＜0.05). In the meantime, the area under the ROC curve was calculated to compare the accuracy of LNR and N staging in evaluating the prognosis of patients. LNR (LNR＜0.6, LNR ≥ 0.6) was significantly better than the traditional N staging in evaluating the value of 3-year OS and 3-year CSS (P＜0.05). 
Conclusion LNR≥0.6 is an independent prognostic risk factor for 3-year CSS in UTUC patients, and the prognostic evaluation value of LNR was significantly better than that of traditional N staging. 


Key words: urologic neoplasms, positive lymph node ratio, SEER database

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