%0 Generic %A L., Wu %A F., Chen %A S., Chen %A L., Wang %D 2018 %T Supplementary Material for: The Lymph Node Ratio Optimizes Staging in Patients with Small Intestinal Neuroendocrine Tumors %U https://karger.figshare.com/articles/dataset/Supplementary_Material_for_The_Lymph_Node_Ratio_Optimizes_Staging_in_Patients_with_Small_Intestinal_Neuroendocrine_Tumors/7000319 %R 10.6084/m9.figshare.7000319.v1 %2 https://karger.figshare.com/ndownloader/files/12842804 %2 https://karger.figshare.com/ndownloader/files/12842807 %2 https://karger.figshare.com/ndownloader/files/12842810 %2 https://karger.figshare.com/ndownloader/files/12842813 %K Small intestinal neuroendocrine tumors %K Tumor %K Lymph node and Metastasis %K Lymph node ratio %K Survival analysis %X Background: The effectiveness of the current Tumor, Lymph node, Metastases (TNM) staging system in small intestinal neuroendocrine tumors (SiNETs) is unsatisfactory. Current N classification only distinguishes between node-negative and node-positive status. We aim to refine the N classification for updated TNM stage. Methods: During the period from 1988 to 2012, patients with non-metastatic ­SiNETs were enrolled in the Surveillance, Epidemiology, and End Results database. Using the X-tile program, we calculated an optimal cutoff value for lymph node ratio (LNR) and proposed a novel Nr category. Survival outcomes were estimated using the Kaplan-Meier method and Cox regression model. Adjusted hazard ratio (HR) and cluster analysis were performed to differentiate TNrM stages. Results: Patients with existing TNM stage I and II had equivalent survival prognosis (p = 0.214). Current N classification was not a significant predictor of patient survival (p = 0.372). Multivariate analyses identified the revised Nr classification, based on LNR of 0.6 optimal cutoff value, as an independent prognostic factor (p = 0.020). By incorporating the Nr classification, a revised TNrM, which categorized patients into 3 new stages was proposed: stage I (T1–2Nr0–1), stage II (T3Nr0–1), and stage III (TxNr2 or T4Nrx). TNrM stage had better stratification according to the survival outcome (primary cohort: stage I: reference, II: HR 3.852, 95% CI 1.731–8.575; III: HR 7.169, 95% CI 3.220–15.963, p < 0.001; validation cohort: stage I: reference, II: HR 2.034; III: HR 3.815; p < 0.001). Conclusions: The Nr classification more accurately stratifies SiNET patients than current N classification. The new TNrM staging system could improve the ability to predict survival outcome of SiNET patients. %I Karger Publishers