Comparison Of The Prognostic Value Of Metastatic Lymph Nodes,lymph Node Ratio And Log Odds Of Positive Lymph Nodes In Siewert Ⅱ Esophagogastric Junction Adenocarcinoma

Objectives: To compare the prognostic value of Metastatic lymph nodes,Lymph node ratio(LNR)and log odds of positive lymph nodes(LODDS)in Siewert II esophagogastric junction adenocarcinoma undergoing surgeryMethods: Using Surveillance,Epidemiology,and End Results(SEER)population-based data,patients with non-metastatic Siewert II EGJA diagnosed between January 1,2004 and December 31,2013 treated with surgery was identified.Correlation of metastatic lymph nodes,LNR and LODDS were analyzed.Relations between log relative hazard and the three node-staging system were plot by Restricted Cubic Spline functions.LNR and LODDS were stratified by X-tile software by the minimal p value approach.Significance of the independent role of the three node staging system were compared by univariate and three-step multivariate Cox proportional hazard model.Prognostic performance of the three node staging system were compared by Likelihood ratio chi-square test,Line trend chi-square test,Harrell’s concordance index and Akaike`s information criterion.Results: Among the 3676 patients with EGJA who underwent surgical resection the mean age was 63.34,the overall 5-years cause-specific survival was 44.1,the lymph nodes metastatic proportion was 54.4%.Correlation of the three staging system is significant.The log relative hazard ratio increased as the three node staging system increased.The best cutoff values were identified as LNR0(0)LMR1(0.0123-0.1818),LNR2(0.1875-0.413793),LMR3(0.4137-1)and LODDS0(-2.2576-1.3979),LODDS1(-1.3862-0.9345),LODDS2(-0.9322-0.3679),LODDS3(-0.3606-1.8512).Significance of the independent role of the three node staging system were LNR stage> LODDS stage> pN stage.The LNR stage has the best discriminatory ability and monotonicity,homogeneity,Prognostic value.The TLnrM staging system based on LNR stage has the best discriminatory ability and monotonicity,homogeneity,accuracy and Prognostic value.Conclusions: Both LNR and LODDS were the significance independent prognostic factors.LNR stage was superior to LODDS stage in prognostic performance.