Prognostic Performance of Different Lymph Node Staging Systems in Patients With Small Bowel Neuroendocrine Tumors

Abstract

Background: The prognostic significance of the lymph node (LN) classification for small bowel neuroendocrine tumors (SBNETs) remains unknown. The aim of the present study was to evaluate and compare the prognostic assessment of different LN staging systems. Methods: Patients with SBNETs were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The X-tile program was used to determine the cutoff value of the resected lymph nodes (RLNs), negative lymph nodes (NLNs), lymph node ratio (LNR), and the log odds of positive lymph nodes (LODDS). Survival analyses were performed using Kaplan–Meier curves with log-rank test. Logistic regression analysis was used to evaluate the differences between different periods. Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of different LN staging systems on cause-specific survival (CSS). The relative discriminative abilities of the different LN staging systems were assessed using the Akaike information criterion (AIC) and the Harrell consistency index (HCI). Result: A total of 3,680 patients were diagnosed with SBNETs between 1988 and 2014 from the SEER database. A significant difference over time (1988–1999 vs. 2000–2014) was seen in age ( P <0.001), tumor differentiation ( P <0.001), T stage ( P <0.001), and RLN ( P <0.001) subgroups. Multivariate Cox survival analysis identified that LN status stratified by the number of RLNs, NLNs, LNR, and LODDS all predicted CSS in patients with SBNETs (all P <0.05), whereas the number of positive lymph nodes (PLNs) failed ( P = 0.452). When assessed using categorical variables, LODDS staging systems showed the best prognostic performance (HCI: 0.766, AIC: 7,575.154) in the whole population. Further analysis based on different RLNs after eliminating the missing data showed that when the RLNs are <12, the LODDS (HCI: 0.769, AIC: 1,088.731) maintained the best prognostic performance as well when the RLNs are ≥12 (HCI: 0.835, AIC: 825.692). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that were better stratified and characterized by the LODDS. Conclusion: LODDS was a better predicator of survival when LN status was stratified as a categorical variable and should be considered when assessing the prognosis of patients with SBNETs to allow a more reliable means to stratify patient survival.

Role of Removed Lymph Nodes on the Prognosis of M0 Small-Bowel Neuroendocrine Tumors: a Propensity Score Matching Analysis from SEER Database

“…In addition, the prognostic value of the PLN ratio in SBNET patients has also been reported, 26 but if the number of ELNs is small, the PLN ratio is often overestimated and cannot truly reflect the actual state of the patient. As an important indicator of the degree of radical cure, NLNs are an independent prognostic factor in a variety of tumors, including gastric cancer, 16 rectal cancer, 10 colon cancer, 27 and lung cancer 18 but have been seldom reported in SBNETs.…”

Number of Positive Lymph Nodes Is Superior to LNR and LODDS for Predicting the Prognosis of Pancreatic Neuroendocrine Neoplasms

“…international cohort study. J Natl Cancer Inst (2012) 104 (10) Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.…”

“…Adding 0.5 to the numerator and denominator avoids division by zero, which aids in stratification of patients without PLNs into different prognostic groups ( 9 ). Recently, LODDS staging was thought a better predictor of survival in the small bowel neuroendocrine tumors compared with LNR and PLN staging ( 10 ). However, the actual prognostic value of LODDS in PanNENs remains unclear.…”

Dynamic nomograms combining N classification with ratio-based nodal classifications to predict long-term survival for patients with lung adenocarcinoma after surgery: a SEER population-based study

“…Although NDLN and NPLN do not contribute to N classification, several studies have confirmed that higher values of NPLN, log odds of positive lymph nodes (LODDS, calculated using the formula: LODDS¼ log NPLN þ0:50 NDLN −NPLN þ0:5 ) or lymph node ratio (LNR, calculated using the formula: LNR¼ NPLN NDLN ) were related to worse prognosis for NSCLC or several other types of malignant tumors [10][11][12][13]. However, of these node classifications, which can obtain the most precise prognosis in lung AC is unclear.…”