Prognostic Value Of Three Lymph Node Staging Methods In Predicting 5-Year Survival Rate After Surgery For Advanced Gastric Cancer

Objective: To analyze the prognostic value of three lymph node staging methods:TNM lymph node staging(p N),positive lymph node metastasis rate(MLR),and positive lymph node logarithmic ratio(LODDS)in predicting the 5-year survival rate of advanced gastric cancer after surgery.Method:Collect clinical and pathological data of 416 patients with advanced gastric cancer diagnosed by the First Affiliated Hospital of Xinjiang Medical University from December 2013 to February 2018 and undergoing D2 radical surgery.Using this scatter plot function in Excel to analyze whether the TNLEs detected during surgery is related to the staging methods of the three lymph node.Firstly using the R language package and X-title software to determine the cutoff values of MLR and LODDS for this experiment for grouping.Secondly,The Kaplan-Meier univariate and COX multivariate regression analysis used to calculate the 5-year overall survival rate(5-YOs)and independent risk factors corresponding to clinical indicators,Using the Log Rank Test to test the difference in 5-year overall survival rate among LODDS,MLR,and p N groups by lymph node stage and plot a K-M survival curve.Finally,a 5-YOSR model for nomogram prediction is established,and the prediction effect is evaluated through the consistency value and the AUC value of the area under the ROC curve.Results:(1)The data from 416 patients eventually included,with complete clinical,pathological and postoperative follow-up data.With January 2023 as the end date and 35±3.3 months(4-78months)follow-up,the5-year overall survival rate was 42.1%,and median survival time was 35 months(4-78 months).The 5-year overall survival rate of 418 advancet gastric caner was 42.1%.The number of lymph nodes detected(TNLE)was 9076,and the average number of lymph nodes was 21±8.3,of which 416(294/416=70.92%)had lymph node metastasis.A total of2416 positive lymph nodes(PLN)were detected,and the average number of PLN was 55±6.3.(2)The spearman correlation analysis: NLNS is moderately correlated with TNLE(r=0.64,P<0.001),p N is moderately correlated with TNLE(r=0.26,P<0.001),MLR is moderately correlated with TNLE(r=-0.05,P=0.09),and LODDS is extremely uncorrelated with TNLE(r=-0.04,P<0.05).(3)Use R language and x-title software to analyze the stages and intercepted values of this group of data: MLR stage:MLR0 stage:(MLR=0);MLR1 stage:(0.00≤MLR<0.30);MLR2 stage:(0.30≤MLR<0.60);MLR3 stage:(0.60≤MLR): LODDS stage:LODDS1 stage:(-1.0≤LODDS0);LODDS2stage:(-1.0<LODDS ≤-0.5);LODDS3 stage:(-0.5<LODDS≤0.0);LODDS4 stage:(0<LODDS).p N stage:p N0 stage(0 pieces);p N1 stage:(1-2pieces);p N2stage:(3-6pieces);p N3 a stage:(7-15pieces);p N3bstage:(≥16pieces).(4)The K-Msurvival curve and univariate analys is:Tumor location(P<0.05),gender(P<0.05),tumor size(P<0.05),vascular invasion(P<0.05),resection range(P<0.05),TNM staging(P<0.001),p N staging(P<0.001),and LODDS staging(P<0.001)are influencing factors for postoperative prognosis of advanced gastric cancer(P<0.05);COX multivariateanalysis: NLNSstaging(P<0.001),gastricresectionrange(P<0.05),tumor site(P<0.05),and differentiation type(P<0.05)are independent risk factors for the prognosis of advanced gastric cancer(P<0.05).(5)Analysis and research of ROC curve show that the ROC curve analysis showed that in the overall sample,the AUC values of LODDS,MLR,and p N staging methods(0.764>0.759>0.733).In addition,in the advanced gastric cancer p N0 samples,the p N and MLR methods have no prognostic staging ability(AUC=0.596),while the LODDS(AUC=0.597)still have certain prognostic staging prediction ability,and There is no significantness difference between the two AUC values(P=0.15).(6)Independent risk factors affecting5-year survival status after operation for advanced gastric cancer: NLNS stage(P<0.001),gastrectomyrange(P<0.001),tumorsite(P<0.001),and differentiation type(P<0.05)are statistically significant.The post-operative prediction nomogram model is drawn using R language,and the AUC value of the nomogram is 0.597,whichhas good prediction and evaluation performance.Conclusion:The prognostic value of LODDS and MLR staging methods in predicting 5-year survival after surgery for advanced gastric cancer is superior to p N staging.