Ratio between negative and positive lymph nodes is a novel prognostic indicator for patients with esophageal cancer: A Surveillance, Epidemiology and End Results database analysis

Abstract

Background: The aim of this study was to explore whether the ratio between negative and positive lymph nodes (R NP) could predict the overall survival (OS) of esophageal cancer (EC) patients with lymph node metastasis following esophagectomy. Methods: We utilized the Surveillance, Epidemiology and End Results (SEER) database to include the records of 2374 patients with lymph node metastases post-surgery. All patients were randomly assigned into the training cohort (n = 1424) and validation cohort (n = 950). Multivariate Cox regression analyses were performed to identify independent prognostic factors. A novel R NP-based TR NP M staging system was proposed. The prognostic value of N, R NP , TNM and TR NP M staging system was evaluated using the linear trend χ 2 test, likelihood ratio χ 2 test, and Akaike information criterion (AIC) to determine the potential superiorities. We constructed nomograms to predict survival in both cohorts, and the calibration curves confirmed the predictive ability. Results: Univariate analyses showed that N and R NP stage significantly influenced the OS of patients. Multivariate analyses revealed that R NP was an independent prognostic predictor in both the training and validation cohorts. For the stratification analysis in the two cohorts, we found significant differences in the prognosis of patients in different R NP groups on the basis of the different N stages and the number of dissected lymph nodes. In addition, the lower AIC value of R NP stage and TR NP M staging system represented superior predictive accuracy for OS than the N stage and TNM staging system, respectively. Furthermore, the calibration curves for the probability of three-and five-year survival showed good consistency between nomogram predictive abilities and actual observation. Conclusions: We demonstrated that compared to the classical pathological lymph nodal staging system, the R NP stage showed superior predictive accuracy for OS and can serve as a more effective prognostic guidance for lymph node positive EC patients.

The prognostic performance of the log odds of positive lymph nodes in patients with esophageal squamous cell carcinoma: A population study of the US SEER database and a Chinese single‐institution cohort

“…10 Considering this situation, several studies have adopted novel LN classification systems combined with the number of removed LNs to assess ESCC prognosis. To the best of our knowledge, the number of NLNs, 25,26 ratio between negative and positive LNs (R NP ), 27 LNR, 28 and LODDS 29 are promising prognostic risk variables among several alternative systems. 30 The LNR has shown superiority over the N stage in reflecting the degree of LNM and predicting patient survival according to some previous studies.…”

Prognostic prediction and comparison of three staging programs for patients with advanced (T2-T4) esophageal squamous carcinoma after radical resection

“…Hence, numerous academics and investigators have sought innovative methods to classify lymph nodes, considering both the quantity of lymph nodes examined and other factors, to assess the long-term prognosis of individuals with esophageal carcinoma post-surgery. These methods include evaluating the number of negative lymph nodes (NLN) ( 25 ), the ratio of negative to positive lymph nodes (RNP) ( 26 ), the lymph node ratio (LNR) ( 27 ), and the log odds of positive lymph nodes (LODDS) ( 28 ).…”

The Prognostic Value of Postoperative Lymph Node Ratio in Gastric Adenocarcinoma Patients Treated With Neoadjuvant Chemotherapy

“…Previous studies have investigated the association between LNR and survival in several types of solid tumors [21][22][23]. In GC, the association between LNR and survival has been investigated mostly in patients not treated with neoadjuvant therapy [24].…”