Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Department of Pathology, University of Virginia, Charlottesville, Virginia.
Ann Thorac Surg. 2013 Oct;96(4):1163-1170. doi: 10.1016/j.athoracsur.2013.04.031. Epub 2013 Aug 30.
Current TNM non-small cell lung cancer (NSCLC) staging uses only the anatomic location of lymph nodes to define N status. Several other cancer staging systems have found lymph node ratio (LNR)-the number of positive lymph nodes/total lymph nodes resected-to be a better predictor of survival after resection. The purpose of this study is to evaluate LNR as a predictor of recurrence and survival after R0 resection for NSCLC.
A total of 1,143 consecutive patients underwent R0 resection for NSCLC between 1999 and 2008 at a high-volume single institution with 26% (n = 302) having N1 and N2 disease. The primary endpoints of the study were long-term survival and recurrence as a function of LNR. Cox proportional hazard models and Kaplan-Meier survival analyses were utilized to assess associations between LNR, N status, and pathologic stage with survival and recurrence after lung cancer resection.
Median follow-up was 44 months and was complete in 97% of patients. Nodal status of patients in this study was as follows: N0 disease, 73.5%; N1 disease, 18.7%; and N2 disease, 7.8%. There were 132 recurrences in patients with nodal disease (43.7%). The pathologic stage of patients in the study was as follows: stage IIA, 47%; stage IIB, 17%; stage IIIA, 35%; and stage IIIB, 1%. Mean total number of lymph nodes sampled was 11.1 ± 6.0 and mean number of positive lymph nodes 2.4 ± 2.0. Upon statistical modeling, LNR was found to be independently associated with decreased survival after resection for NSCLC (hazard ratio 2.63, confidence interval: 1.41 to 4.91, p = 0.002).
In patients undergoing resection for NSCLC, increasing lymph node ratio is independently associated with decreased survival and decreased time to recurrence after R0 resection.
目前，非小细胞肺癌（NSCLC）的 TNM 分期仅使用淋巴结的解剖位置来定义 N 分期。其他几种癌症分期系统发现，淋巴结比率（LNR-阳性淋巴结总数/切除的总淋巴结数）是预测切除后生存的更好指标。本研究旨在评估 LNR 作为 NSCLC 患者 R0 切除后复发和生存的预测指标。
1999 年至 2008 年间，共有 1143 例连续患者在一家高容量的单一机构接受了 NSCLC 的 R0 切除，其中 26%（n=302）患有 N1 和 N2 疾病。该研究的主要终点是 LNR 作为长期生存和复发的函数。Cox 比例风险模型和 Kaplan-Meier 生存分析用于评估 LNR、N 状态和病理分期与肺癌切除后生存和复发之间的关联。
中位随访时间为 44 个月，97%的患者随访完整。本研究患者的淋巴结状况如下：N0 疾病，73.5%；N1 疾病，18.7%；N2 疾病，7.8%。有 132 例有淋巴结疾病的患者出现复发（43.7%）。该研究患者的病理分期如下：IIA 期，47%；IIB 期，17%；IIIA 期，35%；IIIB 期，1%。平均取样的总淋巴结数为 11.1±6.0，阳性淋巴结数为 2.4±2.0。在统计建模中，LNR 被发现与 NSCLC 切除后生存降低独立相关（风险比 2.63，置信区间：1.41 至 4.91，p=0.002）。
在接受 NSCLC 切除的患者中，淋巴结比率的增加与 R0 切除后生存降低和复发时间缩短独立相关。
