Liu Yang, Shen Jianfei, Liu Liping, Shan Lanlan, He Jiaxi, He Qihua, Jiang Long, Guo Minzhang, Chen Xuewei, Pan Hui, Peng Guilin, Shi Honghui, Ou Limin, Liang Wenhua, He Jianxing
Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China.
J Thorac Dis. 2018 Dec;10(12):6569-6577. doi: 10.21037/jtd.2018.11.49.
The correlation between the number of examined lymph nodes (ELNs) and lung cancer-specific survival (LCSS) of stage IA non-small cell lung cancer (NSCLC) patients, who underwent sublobar resection in which lymph node (LN) sampling was relatively restricted as compared with standard lobectomy remains unclear.
Patients from the Surveillance, Epidemiology, and End Results database with stage IA NSCLC who underwent sublobar resection were categorized based on ELN count (1-6 ≥7; the cut point 7 was identified by Cox model).
Collectively, 3,219 patients with a median follow-up time of 37 months were included in this study (G1: 1-6 ELN, n=2,410; G2: ≥7 ELN, n=809). The 5-year LCSS rate of the G1 and G2 cohorts were 75% and 83%, respectively. Cox analysis suggested that the LCSS of G1 cohort patients was lower as compared with the G2 cohort [hazard ratio (HR) =1.530; 95% confidence interval (CI): 1.240-1.988, P<0.001). Propensity score analysis also showed decreased survival of the matched G1 cohort (HR =1.499; 95% CI: 1.176-1.911; P=0.001).
The data suggested the ELNs ≤6 were associated with poor prognoses. Adequate LN sampling is essential even for stage IA NSCLC patients undergoing sublobar resection.
对于接受亚肺叶切除的IA期非小细胞肺癌（NSCLC）患者，其检查的淋巴结数量（ELN）与肺癌特异性生存率（LCSS）之间的相关性尚不清楚，与标准肺叶切除术相比，亚肺叶切除术中淋巴结（LN）采样相对受限。
将监测、流行病学和最终结果数据库中接受亚肺叶切除的IA期NSCLC患者根据ELN计数进行分类（1 - 6个≥7个；切点7由Cox模型确定）。
本研究共纳入3219例患者，中位随访时间为37个月（G1组：1 - 6个ELN，n = 2410；G2组：≥7个ELN，n = 809）。G1组和G2组的5年LCSS率分别为75%和83%。Cox分析表明，与G2组相比，G1组患者的LCSS较低[风险比（HR）= 1.530；95%置信区间（CI）：1.240 - 1.988，P < 0.001]。倾向评分分析也显示匹配的G1组生存率降低（HR = 1.499；95% CI：1.176 - 1.911；P = 0.001）。
数据表明ELN≤6与预后不良相关。即使对于接受亚肺叶切除的IA期NSCLC患者，充分的LN采样也至关重要。
