[转移淋巴结比率在预测非小细胞肺癌患者预后中的价值]

[Value of metastatic lymph node ratio in predicting the prognosis of non-small cell lung cancer patients].

作者信息

Li Yue, Sun Bing-sheng, Zhang Zhen-fa, Zhang Lian-min, Wang Chang-li

机构信息

Department of Lung Cancer, Tianjin Medical University, Tianjin 300060, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2011 Jun 28;91(24):1682-6.

PMID:21914316

Abstract

OBJECTIVE

To investigate the relationship between the metastatic lymph node ratio (LNR) and the prognosis of non-small cell lung cancer (NSCLC).

METHODS

A total of 301 patients with N1 and N2 NSCLC undergoing curative pulmonectomy were analyzed retrospectively. There were 103 females and 198 males with a median age of 59 years (range: 31 - 78). The correlations between LNR and clinicopathological data were analyzed by χ(2) test. The effects of LNR on overall survival (OS) and disease free survival (DFS) of patients were analyzed by the methods of univariate Kaplan-Meier and multivariate Cox proportional hazard model. The risk groups were classified by LNR on the basis of N staging.

RESULTS

LNR correlated with age, smoking status, pathological type, clinical stage and N stage (P < 0.05). And it also correlated with positive lymph nodes, resected lymph nodes and the number of positive lymph node station (P < 0.001). Kaplan-Meier survival analysis revealed that LNR influenced significantly the lengths of OS (P < 0.001) and DFS (P < 0.001). Cox proportional hazard model showed a high LNR was an independent poor prognostic factor for OS (HR = 2.507, 95%CI 1.612 - 3.900, P < 0.001) and DFS (HR = 1.872, 95%CI 1.182 - 2.964, P = 0.008); and at the same N stage, the low-LNR group was better in OS and DFS than the high-LNR group. After stratification into high-, medium- and low-risk groups, the high- (LNR: > 18%, N-status: N2), intermediate- (LNR: > 18%, N-status: N1; LNR: < 18%, N-status: N2) and low-risk factors (LNR: < 18%, N-status: N1) could efficiently predict the outcomes. The 5-year survival rate (32.8% vs 20.7% vs 6.9%), median survival time (MST) (57 vs 30 vs 16 months), 5-year disease-free survival rate (28.1% vs 16.3% vs 5.5%) and disease-free survival time (38 vs 19 vs 10 months) decreased progressively with the rising risk groups (P < 0.001).

CONCLUSION

LNR may be used to accurately predict the prognosis, guide the treatment of NSCLC and improve its staging.

摘要

目的

探讨转移淋巴结比率（LNR）与非小细胞肺癌（NSCLC）预后的关系。

方法

回顾性分析301例行根治性肺切除术的N1和N2期NSCLC患者。其中女性103例，男性198例，中位年龄59岁（范围：31 - 78岁）。采用χ(2)检验分析LNR与临床病理资料的相关性。采用单因素Kaplan-Meier法和多因素Cox比例风险模型分析LNR对患者总生存（OS）和无病生存（DFS）的影响。根据N分期，依据LNR对风险组进行分类。

结果

LNR与年龄、吸烟状况、病理类型、临床分期及N分期相关（P < 0.05）。且与阳性淋巴结、切除淋巴结及阳性淋巴结站数相关（P < 0.001）。Kaplan-Meier生存分析显示，LNR对OS（P < 0.001）和DFS（P < 0.001）的时长有显著影响。Cox比例风险模型显示，高LNR是OS（HR = 2.507，95%CI 1.612 - 3.900，P < 0.001）和DFS（HR = 1.872，95%CI 1.182 - 2.964，P = 0.008）的独立不良预后因素；在相同N分期下，低LNR组的OS和DFS优于高LNR组。分层为高、中、低风险组后，高风险组（LNR：> 18%，N分期：N2）、中风险组（LNR：> 18%，N分期：N1；LNR：< 18%，N分期：N2）和低风险组（LNR：< 18%，N分期：N1）可有效预测预后。随着风险组升高，5年生存率（32.8% vs 20.7% vs 6.9%）、中位生存时间（MST）（57 vs 30 vs 16个月）、5年无病生存率（28.1% vs 16.3% vs 5.5%）和无病生存时间（38 vs 19 vs 10个月）逐渐降低（P < 0.001）。