Construction of a new staging system for stage N3 gastric cancer based on the metastatic lymph node ratio
10.3760/cma.j.cn113855-20240813-00528
- VernacularTitle:基于转移淋巴结比例的N3期胃癌新分期系统的建立
- Author:
Hongyu ZHANG
1
;
Guanghui LIU
1
;
Yanwei YE
1
;
Chunlin ZHAO
1
;
Yang FU
1
Author Information
1. 郑州大学第一附属医院胃肠外科，郑州 450001
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Lymphatic metastasis;
Neoplasm staging;
Prognosis
- From:
Chinese Journal of General Surgery
2025;40(2):123-130
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the cut-off value of metastatic lymph node ratio (LNR) for stage N3 gastric cancer and construct a new TNM staging system to predict prognosis.Methods:Clinical data of 4 291 patients from Jan 2004 to Dec 2020 in the SEER database and 567 patients from Jan 2016 to Dec 2020 in the First Affiliated Hospital of Zhengzhou University with stage N3 gastric cancer were collected. A new TNrM staging system and a nomogram model were constructed based on the optimal LNR cut-off value and compared with the 8th TNM staging model in terms of prognostic discrimination, prognostic prediction accuracy, and clinical usefulness.Results:The optimal cut-off value of LNR was 0.5. A TNrM staging system was constructed by combining the Nr stage with the T stage. Univariate and multivariate COX regression analyses showed that the TNrM staging system was a significant prognostic factor (all P<0.05). Based on the 8th TNM and TNrM staging system, two nomograms were constructed in the training set and externally validated in the validation set. Compared with the TNM staging model, the TNrM staging model had a larger C-index and area of time-dependent ROC curve(AUC) (training set: 3-year AUC: 66.5 vs. 74.4, 5-year AUC: 68.9 vs. 75.3; validation set: 3-year AUC: 62.3 vs. 73.1, 5-year AUC: 62.6 vs. 75.8), its overall survival prediction curves were closer to the ideal curve in the calibration curve, and its clinical net benefit was greater in the decision curves. Conclusions:Stage N3 gastric cancer patients with a metastatic lymph node ratio >0.5 have a poor prognosis. The TNrM staging nomogram model constructed based on the lymph node ratio has better prognostic discrimination ability and prediction accuracy and more clinical net benefits compared to the 8th edition of TNM staging nomogram model.
