淋巴结比率可预测非小细胞肺癌不同分期的生存情况：一项多中心分析†。
Lymph-node ratio predicts survival among the different stages of non-small-cell lung cancer: a multicentre analysis†.
机构信息
Thoracic Surgery, Regina Elena National Cancer Institute - IFO, Rome, Italy.
Università Cattolica del Sacro Cuore, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
出版信息
Eur J Cardiothorac Surg. 2019 Mar 1;55(3):405-412. doi: 10.1093/ejcts/ezy311.
OBJECTIVES
The prognostic role of the number of resected and metastatic lymph nodes in non-small-cell lung cancer (NSCLC) is still being debated. The aim of this study was to evaluate the impact of lymphadenectomy in addition to the already validated variables in NSCLC survival.
METHODS
From January 2002 to December 2012, data on 4858 patients with NSCLC undergoing anatomical lung resection and hilomediastinal lymphadenectomy in 6 institutions were analysed retrospectively. Established prognostic factors in addition to the number of resected lymph nodes and the ratio between the number of metastatic lymph nodes and the number of resected lymph nodes (NR) were correlated to overall survival (OS) and disease-free survival (DFS) using the multivariable Cox regression model. Harrell's C-statistic with the 95% confidence interval (CI) was determined. Analysis by means of maximally selected log-rank statistics was performed to find optimal cut-off points in order to split patients into groups with different outcome probabilities.
RESULTS
The median numbers of resected lymph nodes and of metastatic lymph nodes were 17 (range 6-85) and 2 (1-36), respectively. Hilar (N1) and mediastinal (N2) metastases were identified in 21.3% and 20.0% of cases, respectively. Overall, the 5-year OS and DFS rates were 54.6% and 44.8%, respectively. At multivariable analysis, age, gender, pathological stage, R0 resection, type of surgery and NR correlated with longer OS rates; the same variables plus tumour grading were further related to DFS. C-statistics were 66.0 (95% CI 62.7-69.4) for DFS and 60.5 (95% CI 58.3-62.6) for OS. An NR <40% significantly correlated with a higher 5-year survival rate in the total sample (OS 57.6% vs 23.8%, P < 0.001; DFS 48.2% vs 11.4, P < 0.001) and in patients with N1 (OS 47.9% vs 36.1%, P = 0.03; DFS 39% vs 24.2%, P = 0.02) and N2 (OS 36.9% vs 21.8%, P < 0.001 DFS 23.9% vs 9.1%, P < 0.001).
CONCLUSIONS
Our study confirms that the number of resected lymph nodes is a strong prognostic indicator in NSCLC. In particular, an NR cut-off value of 40% may predict both OS and DFS.
目的
在非小细胞肺癌（NSCLC）中，切除和转移的淋巴结数量的预后作用仍存在争议。本研究旨在评估除已经验证的 NSCLC 生存变量外，淋巴结清扫术的影响。
方法
回顾性分析了 2002 年 1 月至 2012 年 12 月在 6 家机构接受解剖性肺切除术和肺门纵隔淋巴结清扫术的 4858 例 NSCLC 患者的数据。使用多变量 Cox 回归模型，将除了切除的淋巴结数量和转移的淋巴结数量与切除的淋巴结数量之比（NR）之外的既定预后因素与总生存率（OS）和无病生存率（DFS）相关联。确定了 Harrell 的 C 统计量及其 95%置信区间（CI）。通过最大选择对数秩统计分析来确定最佳截止点，以便将患者分为具有不同结局概率的组。
结果
中位切除淋巴结数和转移淋巴结数分别为 17（范围 6-85）和 2（1-36）。分别在 21.3%和 20.0%的病例中发现了肺门（N1）和纵隔（N2）转移。总体而言，5 年 OS 和 DFS 率分别为 54.6%和 44.8%。在多变量分析中，年龄、性别、病理分期、R0 切除、手术类型和 NR 与较长的 OS 率相关；同样的变量加上肿瘤分级进一步与 DFS 相关。DFS 的 C 统计量为 66.0（95%CI 62.7-69.4），OS 为 60.5（95%CI 58.3-62.6）。NR<40%与总样本（OS 57.6%比 23.8%，P<0.001；DFS 48.2%比 11.4%，P<0.001）和 N1（OS 47.9%比 36.1%，P=0.03；DFS 39%比 24.2%，P=0.02）和 N2（OS 36.9%比 21.8%，P<0.001DFS 23.9%比 9.1%，P<0.001）患者的 5 年生存率显著相关。
结论
我们的研究证实，切除的淋巴结数量是非小细胞肺癌的一个强有力的预后指标。特别是，NR 截断值为 40%可能预测 OS 和 DFS。
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