Division of Thoracic Surgery, Department of Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
J Thorac Oncol. 2011 Nov;6(11):1865-71. doi: 10.1097/JTO.0b013e31822a35c3.
Lymph node (LN) status is a major determinant of stage and survival in patients with lung cancer. In the 7th edition of the TNM Classification of Malignant Tumors, the number of involved LNs is included in the definition of pN factors in breast, stomach, esophageal, and colorectal cancer, and the pN status significantly correlates with prognosis.
We retrospectively investigated the prognostic impact of the number of resected LNs (RLNs) and involved LNs in the context of other established clinical prognostic factors, in a series of 928 consecutive patients with non-small cell lung cancer (NSCLC) who underwent complete resection at our institution between 2000 and 2007.
The mean number of RLNs was 15. There was a significant difference in the total number of RLNs categorized between less than 10 and ≥10 (p = 0.0129). Although the incidence of LN involvement was statistically associated with poor prognosis, the largest statistically significant increase in overall survival was observed between 0 to 3 and ≥4 involved LNs (hazard ratio = 7.680; 95% confidence interval = 5.051-11.655, p < 0.0001). On multivariate analysis, we used the ratio between the number of involved LNs and RLNs. The number of RLNs was found to be a strong independent prognostic factor for NSCLC (hazard ratio = 6.803; 95% confidence interval = 4.137-11.186, p < 0.0001).
Complete resection including 10 or more LNs influenced survival at complete NSCLC resection. Four involved LNs seemed to be a benchmark for NSCLC prognosis. The number of involved LNs is a strong independent prognostic factor in NSCLC, and the results of this study may provide new information for determining the N category in the next tumor, node, metastasis classification.
淋巴结（LN）状态是肺癌患者分期和生存的主要决定因素。在第 7 版恶性肿瘤 TNM 分类中，乳腺癌、胃癌、食管癌和结直肠癌的 pN 因素中包含了受累淋巴结的数量，pN 状态与预后显著相关。
我们回顾性研究了在本机构 2000 年至 2007 年间接受完全切除术的 928 例连续非小细胞肺癌（NSCLC）患者中，其他既定临床预后因素背景下，切除的淋巴结数量（RLNs）和受累淋巴结数量的预后影响。
平均 RLNs 数量为 15 个。RLNs 数量少于 10 个和大于等于 10 个之间存在显著差异（p = 0.0129）。尽管淋巴结受累的发生率与预后不良有统计学关联，但在 0 至 3 个和≥4 个受累淋巴结之间观察到总体生存率的最大统计学显著增加（风险比= 7.680；95%置信区间= 5.051-11.655，p < 0.0001）。在多变量分析中，我们使用受累淋巴结与 RLNs 数量的比值。RLNs 数量被发现是非小细胞肺癌的一个强有力的独立预后因素（风险比= 6.803；95%置信区间= 4.137-11.186，p < 0.0001）。
完全切除包括 10 个或更多的淋巴结会影响 NSCLC 的完全切除后的生存。4 个受累淋巴结似乎是非小细胞肺癌预后的基准。受累淋巴结的数量是非小细胞肺癌的一个强有力的独立预后因素，本研究的结果可能为下一个肿瘤、淋巴结、转移分类中的 N 分类提供新的信息。
