OBJECTIVE: To compare the prognostic performance of American Joint Committee on Cancer/International Union Against Cancer seventh N stage relative to lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS), and N score in gastric adenocarcinoma. BACKGROUND: Metastatic disease to the regional LN basin is a strong predictor of worse long-term outcome following curative intent resection of gastric adenocarcinoma. METHODS: A total of 804 patients who underwent surgical resection of gastric adenocarcinoma were identified from a multi-institutional database. The relative discriminative abilities of the different LN staging/scoring systems were assessed using the Akaike's Information Criterion (AIC) and the Harrell's concordance index (c statistic). RESULTS: Of the 804 patients, 333 (41.4%) had no lymph node metastasis, whereas 471 (58.6%) had lymph node metastasis. Patients with ≥N1 disease had an increased risk of death (hazards ratio = 2.09, 95% confidence interval: 1.68-2.61; P < 0.001]. When assessed using categorical cutoff values, LNR had a somewhat better prognostic performance (C index: 0.630; AIC: 4321.9) than the American Joint Committee on Cancer seventh edition (C index: 0.615; AIC: 4341.9), LODDS (C index: 0.615; AIC: 4323.4), or N score (C index: 0.620; AIC: 4324.6). When LN status was modeled as a continuous variable, the LODDS staging system (C index: 0.636; AIC: 4304.0) outperformed other staging/scoring systems including the N score (C index: 0.632; AIC: 4308.4) and LNR (C index: 0.631; AIC: 4225.8). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that was better stratified and characterized by the LODDS. CONCLUSIONS: When assessed as a categorical variable, LNR was the most powerful manner to stratify patients on the basis of LN status. LODDS was a better predicator of survival when LN status was modeled as a continuous variable, especially among those patients with either very low or high LNR.
OBJECTIVE: To compare the prognostic performance of American Joint Committee on Cancer/International Union Against Cancer seventh N stage relative to lymph node ratio (LNR), log odds of metastatic lymph nodes (LODDS), and N score in gastric adenocarcinoma. BACKGROUND: Metastatic disease to the regional LN basin is a strong predictor of worse long-term outcome following curative intent resection of gastric adenocarcinoma. METHODS: A total of 804 patients who underwent surgical resection of gastric adenocarcinoma were identified from a multi-institutional database. The relative discriminative abilities of the different LN staging/scoring systems were assessed using the Akaike's Information Criterion (AIC) and the Harrell's concordance index (c statistic). RESULTS: Of the 804 patients, 333 (41.4%) had no lymph node metastasis, whereas 471 (58.6%) had lymph node metastasis. Patients with ≥N1 disease had an increased risk of death (hazards ratio = 2.09, 95% confidence interval: 1.68-2.61; P < 0.001]. When assessed using categorical cutoff values, LNR had a somewhat better prognostic performance (C index: 0.630; AIC: 4321.9) than the American Joint Committee on Cancer seventh edition (C index: 0.615; AIC: 4341.9), LODDS (C index: 0.615; AIC: 4323.4), or N score (C index: 0.620; AIC: 4324.6). When LN status was modeled as a continuous variable, the LODDS staging system (C index: 0.636; AIC: 4304.0) outperformed other staging/scoring systems including the N score (C index: 0.632; AIC: 4308.4) and LNR (C index: 0.631; AIC: 4225.8). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that was better stratified and characterized by the LODDS. CONCLUSIONS: When assessed as a categorical variable, LNR was the most powerful manner to stratify patients on the basis of LN status. LODDS was a better predicator of survival when LN status was modeled as a continuous variable, especially among those patients with either very low or high LNR.
Authors: Laura Ruspi; Federica Galli; Francesco Frattini; Chiara Peverelli; Giuseppe Di Rocco; Francesco Martignoni; Francesca Rovera; Luigi Boni; Gianlorenzo Dionigi; Stefano Rausei Journal: Transl Gastroenterol Hepatol Date: 2016-03-16
Authors: Neda Amini; Yuhree Kim; Ana Wilson; Georgios Antonios Margonis; Cecilia G Ethun; George Poultsides; Thuy Tran; Kamran Idrees; Chelsea A Isom; Ryan C Fields; Bradley Krasnick; Sharon M Weber; Ahmed Salem; Robert C G Martin; Charles Scoggins; Perry Shen; Harveshp D Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Rivfka Shenoy; Shishir K Maithel; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2016-05-05 Impact factor: 5.344
Authors: Oh Kyoung Kwon; Se Won Kim; Hyun-Dong Chae; Seung Wan Ryu; Ho Young Chung; Sang Woon Kim; Won Kee Lee; Wansik Yu Journal: Ann Surg Treat Res Date: 2016-11-25 Impact factor: 1.859
Authors: Yuhree Kim; Malcolm H Squires; George A Poultsides; Ryan C Fields; Sharon M Weber; Konstantinos I Votanopoulos; David A Kooby; David J Worhunsky; Linda X Jin; William G Hawkins; Alexandra W Acher; Clifford S Cho; Neil Saunders; Edward A Levine; Carl R Schmidt; Shishir K Maithel; Timothy M Pawlik Journal: Surgery Date: 2017-05-31 Impact factor: 3.982
Authors: Fabio Bagante; Thuy Tran; Gaya Spolverato; Andrea Ruzzenente; Stefan Buttner; Cecilia G Ethun; Bas Groot Koerkamp; Simone Conci; Kamran Idrees; Chelsea A Isom; Ryan C Fields; Bradley Krasnick; Sharon M Weber; Ahmed Salem; Robert C G Martin; Charles Scoggins; Perry Shen; Harveshp D Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Gerardo Vitiello; Jan N M IJzermans; Shishir K Maithel; George Poultsides; Alfredo Guglielmi; Timothy M Pawlik Journal: J Am Coll Surg Date: 2016-02-26 Impact factor: 6.113