Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan.
Interact Cardiovasc Thorac Surg. 2020 Sep 1;31(3):305-314. doi: 10.1093/icvts/ivaa107.
Characterizing pathological nodes (pNs) by location alone is sometimes inadequate as patients with pN1 or pN2 non-small-cell lung cancer (NSCLC) show prognostic heterogeneity. We aimed to assess the relationship of the number of metastatic lymph nodes (LNs) and zones with prognosis in NSCLC patients.
We analysed 1393 patients who underwent lobectomy with mediastinal LN dissection for NSCLC at the Osaka International Cancer Institute between January 2006 and December 2015. Patients were classified into 3 groups according to the number of LNs: n1-3, n4-6 and n7-. We investigated the relationship of prognosis with the number of metastatic LNs and metastatic zones.
In the multivariable analyses, the number of metastatic LNs and zones were not independent factors for overall survival or recurrence-free survival in patients with pN1 disease after adjustment for age, sex, tumour histology and tumour diameter. However, n4-6 (ref. n1-3) was an independent prognostic factor for overall survival [hazard ratio (HR) 4.148, P < 0.001] in those with pN2 disease. There were no significant differences in overall survival and recurrence-free survival between pN1 (HR 0.674, P = 0.175) and pN2n1-3 disease (HR 1.056, P = 0.808). Moreover, patients with pN2 disease with a higher number of metastatic zones had a poor prognosis for recurrence-free survival [3 zones (ref. 1): HR 1.774, P = 0.051, and 4 zones (ref. 1): HR 2.173, P < 0.047].
The number of metastatic LNs and metastatic zones were useful prognostic factors in NSCLC patients. The findings could help in establishing a new pN classification.
仅根据位置对病理性淋巴结（pN）进行分类有时是不够的，因为 pN1 或 pN2 非小细胞肺癌（NSCLC）患者的预后存在异质性。我们旨在评估 NSCLC 患者转移淋巴结（LNs）数量和区域与预后的关系。
我们分析了 2006 年 1 月至 2015 年 12 月期间在大阪国际癌症研究所接受肺叶切除术和纵隔淋巴结清扫术的 1393 例 NSCLC 患者。根据淋巴结数量将患者分为 3 组：n1-3、n4-6 和 n7-。我们研究了预后与转移淋巴结数量和转移区域的关系。
在多变量分析中，在调整年龄、性别、肿瘤组织学和肿瘤直径后，转移淋巴结和区域的数量不是 pN1 疾病患者总生存或无复发生存的独立因素。然而，在 pN2 疾病患者中，n4-6（参考 n1-3）是总生存的独立预后因素[风险比（HR）4.148，P<0.001]。pN1（HR 0.674，P=0.175）和 pN2n1-3 疾病（HR 1.056，P=0.808）患者的总生存和无复发生存率无显著差异。此外，pN2 疾病患者转移区域较多者无复发生存率较差[3 个区域（参考 1）：HR 1.774，P=0.051，4 个区域（参考 1）：HR 2.173，P<0.047]。
转移淋巴结和转移区域的数量是 NSCLC 患者有用的预后因素。这些发现有助于建立新的 pN 分类。
