University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ.
Division of Hematology and Oncology and Palliative Care Medicine, Mount Sinai School of Medicine, New York, NY.
Chest. 2011 Aug;140(2):433-440. doi: 10.1378/chest.10-2885. Epub 2011 Feb 3.
Lymph node (LN) status is an important component of staging; it provides valuable prognostic information and influences treatment decisions. However, the prognostic significance of the number of positive LNs in N1 non-small cell lung cancer (NSCLC) remains unclear. In this study we evaluated whether a higher number of positive LNs results in worse survival among patients with N1 disease.
The Surveillance, Epidemiology, and End Results database was used to identify 3,399 patients who underwent resection for N1 NSCLC. Subjects were categorized into groups based on the number of positive nodes: one, two to three, four to eight, and more than eight positive LNs. The prognostic significance of the number of positive LNs in relation to survival was evaluated using the Kaplan-Meier method. Stratified and Cox regression analysis were used to evaluate the relationship between the number of positive LNs and survival after adjusting for potential confounders.
Unadjusted survival analysis showed that a greater number of N1 LNs was associated with worse lung cancer-specific (P < .0001) and overall (P < .0001) survival. Mean lung cancer-specific survival was 8.8, 8.2, 6.0, and 3.9 years for patients with one, two to three, four to eight, and more than eight positive LNs, respectively. Stratified and adjusted analysis also showed the number of N1 LNs was an independent predictor of survival after controlling for potential confounders.
The number of positive LNs is an independent prognostic factor of survival in patients with N1 NSCLC. This information may be used to further stratify patients with respect to risk of recurrence in order to determine postoperative management.
淋巴结（LN）状态是分期的重要组成部分；它提供了有价值的预后信息，并影响治疗决策。然而，N1 非小细胞肺癌（NSCLC）中阳性淋巴结数量的预后意义尚不清楚。在这项研究中，我们评估了 N1 疾病患者中阳性淋巴结数量是否与生存结果更差有关。
使用监测、流行病学和最终结果数据库，确定了 3399 例接受 N1 NSCLC 切除术的患者。根据阳性淋巴结数量将患者分为以下几组：一个、两到三个、四到八个和八个以上。采用 Kaplan-Meier 法评估阳性淋巴结数量与生存之间的预后意义。采用分层和 Cox 回归分析，在调整潜在混杂因素后，评估阳性淋巴结数量与生存之间的关系。
未调整的生存分析表明，更多的 N1 淋巴结与更差的肺癌特异性（P<0.0001）和总体（P<0.0001）生存率相关。阳性淋巴结数为一个、两到三个、四到八个和八个以上的患者的肺癌特异性中位生存时间分别为 8.8、8.2、6.0 和 3.9 年。分层和调整分析还表明，在控制潜在混杂因素后，N1 淋巴结数量是生存的独立预测因素。
阳性淋巴结数量是 N1 NSCLC 患者生存的独立预后因素。该信息可用于进一步分层患者的复发风险，以确定术后管理。
