Università Cattolica del Sacro Cuore, Rome, Italy; Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Thoracic Surgery Unit Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Clin Lung Cancer. 2020 Sep;21(5):464-471.e1. doi: 10.1016/j.cllc.2020.03.004. Epub 2020 Mar 20.
Unexpected N2 involvement occurs in approximately 10% to 20% of patients with non-small-cell lung cancer (NSCLC) and patients' prognostic factors remain unclear. The aim of this study was to evaluate prognostic factors in these patients.
From January 2002 to December 2012, we retrospectively analyzed data of 550 patients with NSCLC with preoperative negative, but pathologic positive N2 involvement, who underwent anatomical lung resection and hilo-mediastinal lymphadenectomy, obtained from 6 institutions. An established prognostic factor panel and N2-type involvement were correlated to overall (OS), cancer-specific (CSS), and disease-free survival (DFS) using multivariate Cox Regression model. The following lymph node patterns were analyzed: number of resected nodes (#RNs), metastatic nodes (#MNs), ratio between #MNs and #RNs (NR), N2 subgroups proposed for the eighth TNM edition, and lobe-specific versus nonspecific metastasis.
Regarding our cohort, 419 patients were staged IIIA (T1-2N2), 131 IIIB (T3-4 N2), 113 pT1, 306 pT2, 94 pT3, and 37 pT4; 5-year OS, DFS, and CSS were 34.1%, 20.1%, and 64.6%, respectively. Independent prognostic factor for OS, in the multivariable analysis, were as follows: NR <17% (P = .009), proposed N2 classification subgroups (P = .014), age <66 (P < .001), and pT (P = .005); for DFS: NR <17% (P = .003), adjuvant treatment (P = .026), and pT (P = .026); and for CSS: NR <17% (P = .008), grading (P = .001), and adjuvant treatment (P < .001).
Our study confirms that adjuvant therapy is fundamental and NR, in patients with unexpected N2 involvement, has a strong prognostic factor. In particular, a NR cutoff value of 17% could predict OS, DFS, and CSS in patients with NSCLC.
大约 10%至 20%的非小细胞肺癌（NSCLC）患者会出现意外的 N2 累及，患者的预后因素仍不清楚。本研究旨在评估这些患者的预后因素。
本研究回顾性分析了 2002 年 1 月至 2012 年 12 月间 6 家机构的 550 例术前检查未见 N2 转移而术后病理检查为 N2 阳性的 NSCLC 患者的临床资料。这些患者均接受了解剖性肺切除术和肺门纵隔淋巴结清扫术。采用多因素 Cox 回归模型，对已建立的预后因素与总生存（OS）、癌症特异性生存（CSS）和无病生存（DFS）进行了相关性分析。本研究分析了以下淋巴结模式：切除淋巴结的数量（#RNs）、转移淋巴结的数量（#MNs）、#MNs 与#RNs 的比值（NR）、第八版 TNM 提出的 N2 亚组以及叶特异性与非特异性转移。
在本研究队列中，419 例患者分期为 IIIA（T1-2N2），131 例为 IIIB（T3-4N2），113 例为 pT1，306 例为 pT2，94 例为 pT3，37 例为 pT4。5 年 OS、DFS 和 CSS 分别为 34.1%、20.1%和 64.6%。多变量分析中，OS 的独立预后因素如下：NR<17%（P=0.009）、提出的 N2 分类亚组（P=0.014）、年龄<66 岁（P<0.001）和 pT（P=0.005）；DFS 的独立预后因素为：NR<17%（P=0.003）、辅助治疗（P=0.026）和 pT（P=0.026）；CSS 的独立预后因素为：NR<17%（P=0.008）、分级（P=0.001）和辅助治疗（P<0.001）。
本研究证实，辅助治疗至关重要，而 NR 是意外 N2 累及患者的一个强有力的预后因素。特别是，NR 截断值为 17%可预测 NSCLC 患者的 OS、DFS 和 CSS。
