Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma

Gaya Spolverato, Aslam Ejaz, Yuhree Kim, Malcolm H. Squires, George Poultsides, Ryan C. Fields, Mark Bloomston, Sharon M. Weber, Konstantinos Votanopoulos, Alexandra W. Acher, Linda X. Jin, William G. Hawkins, Carl Schmidt, David A. Kooby, David Worhunsky, Neil Saunders, Clifford S. Cho, Edward A. Levine, Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)991-998
Number of pages8
JournalAnnals of Surgery
Volume262
Issue number6
DOIs
StatePublished - 2015

Fingerprint

Stomach
Adenocarcinoma
Lymph Nodes
Neoplasm Metastasis
Neoplasms
Odds Ratio
Databases
Confidence Intervals
Survival

Keywords

  • AJCC staging
  • Gastric adenocarcinoma
  • LNR
  • LODDS
  • Lymph node

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Spolverato, G., Ejaz, A., Kim, Y., Squires, M. H., Poultsides, G., Fields, R. C., ... Pawlik, T. M. (2015). Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma. Annals of Surgery, 262(6), 991-998. https://doi.org/10.1097/SLA.0000000000001040

Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma. / Spolverato, Gaya; Ejaz, Aslam; Kim, Yuhree; Squires, Malcolm H.; Poultsides, George; Fields, Ryan C.; Bloomston, Mark; Weber, Sharon M.; Votanopoulos, Konstantinos; Acher, Alexandra W.; Jin, Linda X.; Hawkins, William G.; Schmidt, Carl; Kooby, David A.; Worhunsky, David; Saunders, Neil; Cho, Clifford S.; Levine, Edward A.; Maithel, Shishir K.; Pawlik, Timothy M.

In: Annals of Surgery, Vol. 262, No. 6, 2015, p. 991-998.

Research output: Contribution to journalArticle

Spolverato, G, Ejaz, A, Kim, Y, Squires, MH, Poultsides, G, Fields, RC, Bloomston, M, Weber, SM, Votanopoulos, K, Acher, AW, Jin, LX, Hawkins, WG, Schmidt, C, Kooby, DA, Worhunsky, D, Saunders, N, Cho, CS, Levine, EA, Maithel, SK & Pawlik, TM 2015, 'Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma', Annals of Surgery, vol. 262, no. 6, pp. 991-998. https://doi.org/10.1097/SLA.0000000000001040
Spolverato, Gaya ; Ejaz, Aslam ; Kim, Yuhree ; Squires, Malcolm H. ; Poultsides, George ; Fields, Ryan C. ; Bloomston, Mark ; Weber, Sharon M. ; Votanopoulos, Konstantinos ; Acher, Alexandra W. ; Jin, Linda X. ; Hawkins, William G. ; Schmidt, Carl ; Kooby, David A. ; Worhunsky, David ; Saunders, Neil ; Cho, Clifford S. ; Levine, Edward A. ; Maithel, Shishir K. ; Pawlik, Timothy M. / Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma. In: Annals of Surgery. 2015 ; Vol. 262, No. 6. pp. 991-998.
@article{b998975425ed444bb3ba413a11f148cb,
title = "Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma",
abstract = "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.",
keywords = "AJCC staging, Gastric adenocarcinoma, LNR, LODDS, Lymph node",
author = "Gaya Spolverato and Aslam Ejaz and Yuhree Kim and Squires, {Malcolm H.} and George Poultsides and Fields, {Ryan C.} and Mark Bloomston and Weber, {Sharon M.} and Konstantinos Votanopoulos and Acher, {Alexandra W.} and Jin, {Linda X.} and Hawkins, {William G.} and Carl Schmidt and Kooby, {David A.} and David Worhunsky and Neil Saunders and Cho, {Clifford S.} and Levine, {Edward A.} and Maithel, {Shishir K.} and Pawlik, {Timothy M.}",
year = "2015",
doi = "10.1097/SLA.0000000000001040",
language = "English (US)",
volume = "262",
pages = "991--998",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Prognostic performance of different lymph node staging systems after curative intent resection for gastric adenocarcinoma

AU - Spolverato, Gaya

AU - Ejaz, Aslam

AU - Kim, Yuhree

AU - Squires, Malcolm H.

AU - Poultsides, George

AU - Fields, Ryan C.

AU - Bloomston, Mark

AU - Weber, Sharon M.

AU - Votanopoulos, Konstantinos

AU - Acher, Alexandra W.

AU - Jin, Linda X.

AU - Hawkins, William G.

AU - Schmidt, Carl

AU - Kooby, David A.

AU - Worhunsky, David

AU - Saunders, Neil

AU - Cho, Clifford S.

AU - Levine, Edward A.

AU - Maithel, Shishir K.

AU - Pawlik, Timothy M.

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - AJCC staging

KW - Gastric adenocarcinoma

KW - LNR

KW - LODDS

KW - Lymph node

UR - http://www.scopus.com/inward/record.url?scp=84948715545&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84948715545&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000001040

DO - 10.1097/SLA.0000000000001040

M3 - Article

VL - 262

SP - 991

EP - 998

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 6

ER -