背景:目前的淋巴结(LN)分期方法在预测SBA的生存率方面存在争议。我们旨在开发一种替代的基于LN分类的列线图,以个性化SBA预后。
方法:根据监测数据,流行病学,在2004年至2014年间诊断为SBA的患者的最终结果(SEER)数据库中,我们使用K自适应分区(KAPS)算法确定了所检查的LN数量和发现的转移数量的截止点.使用转移性LN,得出了预测SBA存活率的列线图,内部和外部验证,并通过校准曲线测量,C指数,和决策曲线分析(DCA),与第8TNM阶段相比。
结果:共纳入1516例患者。17的截止值是最佳的检查LN数。对于转移性LN数,截止点分别为0、2和8。列线图的C指数高于第8期TNM分期(内部:0.734;95%CI,0.693至0.775与0.677;95%CI,0.652至0.702,P<0.001;外部:0.715;95%CI,0.674至0.756。0.648;95%CI,0.602~0.693,P<0.001)。此外,列线图在内部和外部验证中显示良好的校准,且净获益大于TNM分期.
结论:我们根据转移性LN的数量将当前的N分期修改为4级分期系统:N0,无LN转移;N1,1-2个转移性LN;N2,3-8个转移性LN,和N3,>8个转移性LN,并将最少检查的LN数设置为17。基于此分期的列线图显示出比TNM分期更高的临床可用性,可预测SBA患者的生存率。
BACKGROUND: Current methods of lymph node (LN) staging are controversial in predicting the survival of SBA. We aimed to develop an alternative LN-classification-based nomogram to individualize SBA prognosis.
METHODS: Based on the data from the Surveillance, Epidemiology, and End Results (SEER) database of patients diagnosed with SBA between 2004 and 2014, we identified the cut-off points for the number of LNs examined and the number found to be metastatic using the K-adaptive partitioning (KAPS) algorithm. Using metastatic LNs, a nomogram predicting the survival of SBA was derived, internally and externally validated, and measured by calibration curve, C-index, and decision curve analysis (DCA), and compared to the 8th TNM stage.
RESULTS: A total of 1516 patients were included. The cut-off of 17 was the optimal examined LN number. For metastatic LN numbers, the cut-off points were 0, 2, and 8. The C-index for the nomogram was higher than the 8th TNM staging (internal: 0.734; 95% CI, 0.693 to 0.775 vs. 0.677; 95% CI, 0.652 to 0.702, P < 0.001; external: 0.715; 95% CI, 0.674 to 0.756 vs. 0.648; 95% CI, 0.602 to 0.693, P < 0.001). Also, the nomogram showed good calibration in internal and external validation and larger net benefit than TNM staging.
CONCLUSIONS: We modified current N staging into a 4-level staging system based on the number of metastatic LNs: N0, no LN metastasis; N1, 1-2 metastatic LNs; N2, 3-8 metastatic LNs, and N3, >8 metastatic LNs and set the least examined LN number to 17. A nomogram based on this staging showed great clinical usability than TNM staging for predicting the survival of SBA patients.