Comparison of different lymph node staging schemes in prostate cancer patients with lymph node metastasis
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In addition to standard TNM N staging, lymph node ratio (LNR) and log odds of metastatic lymph node (LODDS) staging methods have been developed for cancer staging. We compared the prognostic performance of the total number of lymph nodes examined (TNLE), number of metastatic lymph node (NMLN), LNR, and LODDS in prostate cancer.
Data from 1400 patients diagnosed with prostate cancer between 2004 and 2009 who underwent lymphadenectomy were extracted from the Surveillance Epidemiology and End Results database. Kaplan–Meier methods and multivariable Cox regression analysis were used to evaluate the prognostic value of different lymph node staging schemes in patients with lymph node metastasis.
Univariate analysis showed that age, T stage, radiotherapy history, Gleason score, LNR classification, LODDS classification, and NMLN except TNLE classification were significant prognostic factors for overall survival. In multivariate analysis, LNR classification, LODDS classification, and NMLN but TNLE classification remained significant prognostic factors for overall survival. LNR classification had the highest C-index (0.672; 95% confidence interval [CI]: 0.609–0.734) and the lowest Akaike information criterion (AIC) (4057.018), indicating the best prognostic performance. Scatter plots showed that LODDS increased with increasing LNR, exhibiting a strong overall correlation between these two lymph node staging methods (r2 = 0.9072). LNR and LODDS generally increased with increasing NMLN, although the correlation was relatively low.
Our results indicate that LNR and LODDS may be better predictors of overall survival than the AJCC/UICC N category in patients undergoing curative surgery for prostate cancer.
KeywordsProstate cancer Lymph node staging Lymph node ratio Log odds Prognosis
The authors would like to thank all patients involved in this study and all the staff working for SEER database. This work was funded by the National Natural Science Foundation of China (81572531). The funding source provided financial support for the study and did not have any other involvement in this study. In addition, we thank Clare Cox, PhD, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.
Compliance with ethical standards
Conflict of interest
None of the authors declare competing financial interests.
All the procedures performed in studies involving human participants were in accordance with the ethical standards of the Research Ethics Committee of Shanghai Cancer Center, Fudan University, China and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Research Ethics Committee of Shanghai Cancer Center, Fudan University, China according to the provisions of the Declaration of Helsinki (as revised in Fortaleza, Brazil, October 2013). All patients were identified from the public SEER database. Thus, informed consent was not required.
The public SEER databases have obtained informed consent from all individual participants included in the SEER database before. Therefore, we did not need extra informed consent of the patients. In addition, patients in this study were all anonymous and other personal information was also erased.
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