Liu Hongfeng, Yan Tao, Zhang Tiehong, Chen Xiaowei, Wang Yadong, Du Jiajun
Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University.
Department of Thoracic Surgery. Jining No. 1 People's Hospital, Jining, PR China.
Medicine (Baltimore). 2019 May;98(20):e15645. doi: 10.1097/MD.0000000000015645.
Lymph node metastasis is one of the most important prognostic indicators in patients with radically resected non-small cell lung cancer (NSCLC). This retrospective study aimed to compare the predictive value of metastatic lymph nodes (MNs), lymph node ratio (LNR), resected lymph nodes (RNs), and negative lymph nodes (NNs) with the currently used pathologic nodal (pN) staging category.We conducted a retrospective analysis of 1019 consecutive NSCLC patients treated with complete resection in a single institution. Prognostic values of various lymph node factors were evaluated by analysis of univariate and multivariate Cox proportional hazards model, and the results were compared with those using the location-based pN stage classification.The median follow-up duration was 47 months. During this period, 353 cases of cancer recurrence and 337 deaths were reported. Multivariate cox analysis indicated that both pN and NN categories were independent predictors of patient survival. The patients were divided into six groups on the basis of pN and NN categories. The survival rates of the groups were as follows: pN0, NN≥8, 81.4%; pN0, NN<8, 73.8%; pN1, NN≥8, 61.4%; pN1, NN<8, 54.2%; pN2, NN≥8, 48.4%; and pN2>1, NN<8, 35.0%. Comparison of the predictive values of the lymph node factors showed that the new N category was a more valuable prognostic factor in operable NSCLC.The combination of anatomically based pN stage classification and the number of MNs is an accurate prognostic determinant in patients with operable NSCLC which can be equal to 8th N category.
淋巴结转移是接受根治性切除的非小细胞肺癌（NSCLC）患者最重要的预后指标之一。本回顾性研究旨在比较转移淋巴结（MNs）、淋巴结比率（LNR）、切除淋巴结（RNs）和阴性淋巴结（NNs）与目前使用的病理淋巴结（pN）分期类别的预测价值。我们对在单一机构接受完全切除治疗的1019例连续NSCLC患者进行了回顾性分析。通过单因素和多因素Cox比例风险模型分析评估各种淋巴结因素的预后价值，并将结果与使用基于位置的pN分期分类的结果进行比较。中位随访时间为47个月。在此期间，报告了353例癌症复发和337例死亡。多因素Cox分析表明，pN和NN类别均为患者生存的独立预测因素。根据pN和NN类别将患者分为六组。各组的生存率如下：pN0，NN≥8，81.4%；pN0，NN<8，73.8%；pN1，NN≥8，61.4%；pN1，NN<8，54.2%；pN2，NN≥8，48.4%；pN2>1，NN<8，35.0%。淋巴结因素预测价值的比较表明，新的N类别是可手术NSCLC中更有价值的预后因素。基于解剖学的pN分期分类与MNs数量的组合是可手术NSCLC患者准确的预后决定因素，其等同于第8版N类别。
