淋巴结转移率对胃癌根治术后患者预后的评估价值

目的评估淋巴结转移率（MLR）分期系统对胃癌根治术后患者预后评估的价值。方法依据MLR分期及第6版、第7版UICC指南N分期这3种分期方法，对1042例胃癌D2根治术后患者进行预后分析。比较3种分期方法预测预后的齐性、相关性和梯度变化曲线，以及受试者工作特征（ROC）曲线下面积（AUC）。结果1042例患者术后5年生存率为47．5％，单因素和多因素预后分析显示，MLR分期（P〈0．01）和第7版N分期（P〈0．05）均为1042例胃癌患者的独立预后因素。MLR分期预测预后的AUC为0．754．高于第6版N分期的0．692和第7版N分期的0．705。与第6版、第7版N分期比较，MLR分期预测预后具有更好的齐性和线性曲线，Akaike信息标准化值更低（7240．017比7364．073和7325．731）。结论MLR分期对胃癌根治术患者的预后预测价值优于UICC指南中的N分期．有望成为一种新的淋巴结分期方法。

Prognostic value of metastatic lymph node ratio in gastric cancer patients undergoing radical gastrectomy

Objective To assess the prognostic value of metastatic lymph node ratio in gastric cancer patients undergoing radical gastrectomy（D2）. Methods Prognostic analysis of 1042 gastric cancer patients undergoing radical gastrectomy（D2） was performed based on metastatic lymph node ratio （MLR）, the N staging in the 6th and 7th edition of UICC staging system respectively. Homogeneity, discriminatory ability, and gradient monotonicity of these three staging methods were compared using linear trend X^2, likelihood ratio X^2 statistics and Akaike information criterion （AIC） calculations, respectively. The area under the ROC curve （AUC） was calculated to compare the prognostic value of these three staging methods. Results The 5-year survival rate of 1042 patients was 47.5%. The metastatic lymph node ratio（P〈0.01） and N staging of the 7th edition UICC（P〈0.05） were independent prognostic factors according to univariate and multivariate analyses. The AUC was 0.754 in MLR staging group, higher than that in N staging of the 6th（0.692） and 7th（0.705） edition of UICC group. Compared to the 6th and 7th edition of UICC N staging group, homogeneity and linear curve were better and AIC value was lower in MLR staging group（7240.017 vs. 7364.073 and 7325.731 ）. Conclusion Prognostic value of MLR staging is better than that of UICC N staging for patients undergoing radical gastric cancer resection. The MLR staging can be a new method of lymph node staging for gastric cancer patients.