Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia.
J Thorac Oncol. 2013 Jul;8(7):940-6. doi: 10.1097/JTO.0b013e318292c53e.
INTRODUCTION: The use of postoperative radiotherapy (PORT) after resection of non-small-cell lung cancer (NSCLC) is controversial, with some evidence suggesting a benefit in patients with N2 disease. We assessed lymph node ratio (LNR) as a predictor of PORT benefit. METHODS: By using the Surveillance, Epidemiology and End Results database, we analyzed resected, node-positive (N1-N2) NSCLC patients diagnosed between 1998 and 2009. LNR, (number of positive nodes/number of resected nodes) was categorized into four groups: LNR less than 12.5%, 12.5 to 24.9%, 25 to 49.9%, and 50% or more. RESULTS: Of 11,324 node-positive NSCLC patients identified, 6551 (57.9%) had N1 disease. The LNR was prognostic for survival in the entire cohort and within each nodal stage. The median survival in LNR groups 1, 2, 3, and 4 was 43, 40, 30, and 23 months in N1 disease and 40, 32, 27, and 22 months in N2 disease, respectively. PORT was associated with a worse survival on univariate analysis (hazard ratio [HR] =1.09; confidence interval [CI] 1.03-1.15; p = 0.002) but no effect on multivariate analysis (HR = 0.96; CI 0.90-1.02; p = 0.201). When analyzed by nodal stage, the benefit of PORT was limited to N2 disease (HR = 0.9; CI 0.84-0.99; p= 0.026) with no benefit in N1 disease (HR = 1.06; CI 0.97-1.15; p=0.2). After stratifying by LNR, the survival benefit of PORT was limited to those with N2 disease and an LNR of 50% or more. CONCLUSION: A high LNR is associated with a poorer survival in resected, node-positive NSCLC. The survival benefit associated with PORT in this disease seems to be limited to those with an LNR of 50% or more. This warrants further investigation in other cohorts and prospective studies.
简介：非小细胞肺癌（NSCLC）切除术后使用辅助放疗（PORT）存在争议，有证据表明 N2 期患者可能从中获益。本研究评估了淋巴结比值（LNR）作为 PORT 获益的预测因子。
方法：利用监测、流行病学和最终结果（SEER）数据库，分析了 1998 年至 2009 年间诊断为淋巴结阳性（N1-N2）的 NSCLC 患者。LNR（阳性淋巴结数/切除淋巴结数）分为四组：LNR＜12.5%、12.5%～24.9%、25%～49.9%和≥50%。
结果：在 11324 例淋巴结阳性 NSCLC 患者中，6551 例（57.9%）为 N1 期疾病。LNR 与整个队列和每个淋巴结分期的生存相关。LNR 组 1、2、3 和 4 的中位生存时间分别为 N1 期疾病的 43、40、30 和 23 个月，N2 期疾病的 40、32、27 和 22 个月。单因素分析显示 PORT 与生存预后较差相关（风险比[HR] 1.09；95%置信区间[CI] 1.03-1.15；p=0.002），但多因素分析无显著影响（HR 0.96；95%CI 0.90-1.02；p=0.201）。按淋巴结分期分析时，PORT 获益仅限于 N2 期（HR 0.9；95%CI 0.84-0.99；p=0.026），N1 期无获益（HR 1.06；95%CI 0.97-1.15；p=0.2）。LNR 分层后，PORT 的生存获益仅限于 N2 期且 LNR≥50%的患者。
结论：LNR 高与 NSCLC 切除后阳性淋巴结患者的生存不良相关。PORT 治疗在该疾病中的生存获益似乎仅限于 LNR≥50%的患者。这需要在其他队列和前瞻性研究中进一步调查。
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