Proposed Modification of Staging for Distal Cholangiocarcinoma Based on the Lymph Node Ratio Using Korean Multicenter Database

You, Yunghun; Shin, Yong Chan; Choi, Dong Wook; Heo, Jin Seok; Shin, Sang Hyun; Kim, Naru; Jang, Kee Taek; Kim, Hongbeom; Lim, Chae‐Seok; Chang, Sun Hee; Han, Kang Min; Han, In Woong

doi:10.3390/cancers12030762

Cited by 14 publications

(12 citation statements)

References 27 publications

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“…Whether age is an independent risk factor for DCC remains controversial. You et al ( 19 ) reported that age was significantly related to the prognosis of DCC, but Chen et al ( 30 ), Wu et al ( 31 ), and the results of this study reached the opposite conclusion. This may be due to the limitations of the different studies.…”

Section: Discussioncontrasting

confidence: 82%

“…Regional LN metastasis is considered to be a key factor in evaluating the prognosis of patients after DCC (7)(8)(9)(10)17), but the effectiveness of the AJCC 8th edition N stage, as the latest and most commonly used stage, remains controversial (7,(17)(18)(19). Compared with AJCC 7th, AJCC 8th edition further subdivided N stage into N0 (PLNN = 0), N1 (PLNN = 1-3) and N2 (PLNN≥4) according to PLNN (11).…”

Section: Discussionmentioning

confidence: 99%

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A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

Sun

et al. 2021

Front. Surg.

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Background: Lymph node (LN) metastasis is considered one of the most important risk factors affecting the prognosis of distal cholangiocarcinoma (DCC). This study aimed to demonstrate the superiority of log odds of positive lymph nodes (LODDS) compared with other LN stages, and to establish a novel prognostic nomogram to predict the cancer-specific survival (CSS) of DCC.Methods: From the Surveillance, Epidemiology and End Results (SEER) database, the data of 676 patients after DCC radical operation were screened, and patients were randomly divided into training (n = 474) and validation sets (n = 474). The prognostic evaluation performance of the LODDS and American Joint Commission on Cancer (AJCC) N stage and lymph node ratio (LNR) were compared using the Akaike information criteria, receiver operating characteristic area under the curve (AUC), and C-index. Multivariate Cox analysis was used to screen independent risk factors, and a LODDS-based nomogram prognostic staging model was established. The nomogram's precision was verified by C-index, calibration curves, and AUC, and the results were compared with those of the AJCC TNM staging system.Results:Compared with the other two stages of LN metastasis, LODDS was most effective in predicting CSS in patients with DCC. Multivariate analysis proved that LODDS, histologic grade, SEER historic stage, and tumor size were independent risk factors for DCC. The C-index of the nomogram, based on the above factors, in the validation set was 0.663. The 1-, 3-, and 5-y AUCs were 0.735, 0.679, and 0.745, respectively. Its good performance was also verified by calibration curves. In addition, the C-index and Kaplan-Meier analysis showed that the nomogram performed better than the AJCC TNM staging system.Conclusion:For postoperative patients with DCC, the LODDS stage yielded better prognostic efficiency than the AJCC N and LNR stages. Compared with the AJCC TNM staging system, the nomogram, based on the LODDS, demonstrated superior performance.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

Sun

et al. 2021

Front. Surg.

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“…The LNR staging system combined with ELNN and PLNN compensates for the impact of insufficient ELNN on staging. A meta-analysis found that LNR = 0.2 is the ideal cutoff value for risk stratification of dCCA patients with radical resection ( 4 ), while the optimal cutoff value based on prognosis was between 0.45 and 0.17 ( 11 , 12 , 29 , 30 ). Similar cutoff values were obtained in our study by using X-tile software: LNR1-3: <0.1, 0.1 to 0.3, and ≥0.3.…”

Section: Discussionmentioning

confidence: 99%

“…Lymph node ratio (LNR), which is the ratio of PLNN to examined lymph node number (ELNN), has been proposed as an indicator of lymph node staging. Several studies have confirmed that the LNR is a promising indicator of the prognosis of dCCA (4,(9)(10)(11)(12). Log odds of positive lymph nodes (LODDS) is the log of the ratio of PLNN to negative lymph node number (NLNN).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…However, the positive LNs factor was not included in the construction of the nomogram plot because the value of AIC was too large. AIC was considered as an important criterion for variable sieving and has been used in many studies 28,29 . Compared with our model, the TNM staging system earlier was not better for survival prediction, while our model was reasonable and logic by multivariate cox regression analysis and AIC algorithm which can prevent over tting of the model and ensure the accuracy of model 30 .…”

Section: Discussionmentioning

confidence: 99%

A Lymph Node Classification-based cancer-specific Survival Predicting Model in Patients with Ampullary cancer: A Derivation and Validation Study

Zhao

Zou

Huang

et al. 2021

Preprint

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Background: Current lymph node (LN) staging is controversial in predicting the survival of ampullary cancer (AC). We aimed to develop an alternative LN-classification-based nomogram to individualize AC prognosis.Methods: Using the data of patients diagnosed with AC between 2004 and 2015 from the SEER database, we determined the cut-off values for the number of LNs examined via the K-adaptive partitioning algorithm. A nomogram predicting the survival of AC patients was performed, internally and externally validated, and evaluated by calibration plot, C-index, and decision curve analysis (DCA), and was compared to the 7th TNM stage.Results: We included 2341 patients with detailed information. The optimal cut-off for examined LN number was 12, while the cut-off value for positive LNs was 0 and 4. The C-index for the nomogram was higher than that of the 7th TNM staging (internal: 0.686; 95% CI, 0.584-0.773 vs. 0.616; 95% CI, 0.533-0.754, P < 0.001; external: 0.713; 95% CI, 0.651-0.784 vs. 0.647; 95% CI, 0.551-0.719, P < 0.001). Additionally, the nomogram showed good agreement between internal and external validation. DCA analysis showed no matter in the internal cohort or external cohort; the nomogram showed a greater benefit across the period of follow-up than did the 7th TNM stage.Conclusion: We found that examined LNs that were more than 12 were beneficial for prognosis of patients. We also modified the current N staging into three groups based on number of metastatic LNs: N0, no LN metastasis; N1, 1–4 metastatic LNs; N2, >=5 metastatic LNs. A nomogram with greater benefit for predicting the survival of patients with AC than TNM staging was constructed.

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Proposed Modification of Staging for Distal Cholangiocarcinoma Based on the Lymph Node Ratio Using Korean Multicenter Database

Cited by 14 publications

References 27 publications

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

A Nomogram Based on the Log Odds of Positive Lymph Nodes Predicts the Prognosis of Patients With Distal Cholangiocarcinoma After Surgery

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

A Lymph Node Classification-based cancer-specific Survival Predicting Model in Patients with Ampullary cancer: A Derivation and Validation Study

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