Prognostic performance of three lymph node staging schemes for patients with Siewert type II adenocarcinoma of esophagogastric junction

Jinming Xu,Zhitian Wang,Yihua Wu,Luming Wang,Yiqing Wang,Jian Hu,Jinlin Cao,Wang Lv

doi:10.1038/s41598-017-09625-z

Jinming Xu, Zhitian Wang + Show 6 more

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https://doi.org/10.1038/s41598-017-09625-z

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Abstract

The prognostic performance of different lymph node staging schemes for adenocarcinoma of esophagogastric junction (AEG) remains controversial. The objective of the present study was to compare the prognostic efficacy of the number of lymph node metastases (LNMs), the positive lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS). Patients diagnosed with Siewert type II AEG were included from the Surveillance, Epidemiology, and End Results database. Harrell’s C-index statistic, Schemper’s proportion of explained variation (PEV), the Akaike information criterion (AIC) and restricted cubic spine analyses were adopted to assess the predictive accuracy of LNM, LNR and LODDS. A total of 1302 patients with post-surgery Siewert type II AEG were included. LNM, LNR and LODDS all showed significant prognostic value in the multivariate Cox regression analyses. LODDS performed higher predictive accuracy than LNM and LNR, with relatively higher C-index, higher Schemper’s PEV value and lower AIC value. For patients with no nodes involved, LODDS still performed significantly discriminatory utility. LODDS showed more accurate prognostic performance than LNM and LNR for post-surgery Siewert type II AEG, and it could help to detect survival heterogeneity for patients with no positive lymph nodes involved.

Highlights

The incidence of adenocarcinoma of esophagogastric junction (AEG) has increased dramatically in both Western and Asian countries over the past several decades[1,2,3,4], which might be caused by the increasing trend of gastroesophageal reflux disease, obesity and smoking[5,6,7,8]
Several different lymph node staging schemes were proposed for esophageal cancer[14, 15] and gastric cancer[16,17,18], including the number of lymph node metastases (LNMs), the positive lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS)
LNR was defined as the ratio of the number of metastatic lymph nodes to the total number of examined lymph nodes[12] and LODDS was defined as the natural logarithm of the ratio of the probability of a lymph node being positive to the probability of a lymph node being negative when a single lymph node is retrieved[19]

Summary

Introduction

The incidence of adenocarcinoma of esophagogastric junction (AEG) has increased dramatically in both Western and Asian countries over the past several decades[1,2,3,4], which might be caused by the increasing trend of gastroesophageal reflux disease, obesity and smoking[5,6,7,8]. AEG was staged identically to the staging criteria of esophageal cancer in AJCC 7th edition and the absolute number of lymph node metastases (LNMs) is currently used for the N stage. It has been reported that the current nodal staging criteria could be influenced by total number of lymph node retrieved and might cause stage migration[12, 13]. Several different lymph node staging schemes were proposed for esophageal cancer[14, 15] and gastric cancer[16,17,18], including the number of LNMs, the positive lymph node ratio (LNR) and the log odds of positive lymph nodes (LODDS). The comparison of three lymph node staging schemes has not been evaluated for Siewert type II AEG, and it’s important to find the optimal prognostic indicator to provided evidence and www.nature.com/scientificreports/. The aim of this study was to compare the prognostic efficacy of LNM, LNR and LODDS in patients with post-surgery Siewert type II AEG using the Surveillance, Epidemiology, and End Results (SEER) database of 18 registries

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