Moon Duk Hwan, Choi Jin-Ho, Yang Hee Chul, Kim Moon Soo, Lee Jong Mog, Lee Geon-Kook, Jeon Jae Hyun
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Thorac Dis. 2020 Nov;12(11):6514-6522. doi: 10.21037/jtd-20-2039.
This study assessed the prognostic significance of metastatic lymph node size (MLNS) and extranodal extension (EN) in patients with node-positive lung adenocarcinoma (ADC).
Prognostic factors influencing survival were analyzed, including age, sex, extent of operation, T- and N-stage, size of tumor, postoperative chemotherapy, presence of EN, and MLNS (>7.0 ≤7.0 mm).
Three hundred seventy-five patients met the inclusion criteria were enrolled (mean age: 59.8±10.5 years). Increasing MLNS was significantly correlated with large tumor size (P=0.015), advanced N status (P<0.001), and presence of EN (P<0.001). In multivariable analysis, large tumor size [hazard ratio (HR) 1.135, 95% confidence interval (CI): 1.050 to 1.228, P<0.001], adjuvant chemotherapy (HR 0.582, 95% CI: 0.430 to 0.787, P<0.001), EN (HR 1.454, 95% CI: 1.029 to 2.055, P=0.034), and MLNS greater than 7 mm (HR 1.741, 95% CI: 1.238 to 2.447, P<0.001) were significant prognostic factors for survival. Patients were classified into 3 groups: Group A, MLNS ≤7.0 mm/EN (-); Group B, MLNS ≤7.0 mm/EN (+) or MLNS >7.0 mm/EN (-); and Group C, MLNS >7.0 mm/EN (+). The 5-year overall survival (OS) was 72.2%, 59.0%, and 38.5% in Groups A, B and C, respectively (P<0.001).
The MLNS and presence of EN could provide an important prognostic implication for patients with node-positive lung ADC.
本研究评估了转移性淋巴结大小（MLNS）和结外侵犯（EN）在淋巴结阳性肺腺癌（ADC）患者中的预后意义。
分析影响生存的预后因素，包括年龄、性别、手术范围、T分期和N分期、肿瘤大小、术后化疗、EN的存在以及MLNS（>7.0≤7.0mm）。
375例符合纳入标准的患者入组（平均年龄：59.8±10.5岁）。MLNS增加与肿瘤体积大（P=0.015）、N分期高（P<0.001）和EN的存在（P<0.001）显著相关。在多变量分析中，肿瘤体积大[风险比（HR）1.135，95%置信区间（CI）：1.050至1.228，P<0.001]、辅助化疗（HR 0.582，95%CI：0.430至0.787，P<0.001）、EN（HR 1.454，95%CI：1.029至2.055，P=0.034）和MLNS大于7mm（HR 1.741，95%CI：1.238至2.447，P<0.001）是生存的重要预后因素。患者分为3组：A组，MLNS≤7.0mm/EN（-）；B组，MLNS≤7.0mm/EN（+）或MLNS>7.0mm/EN（-）；C组，MLNS>7.0mm/EN（+）。A、B和C组的5年总生存率（OS）分别为72.2%、59.0%和38.5%（P<0.001）。
MLNS和EN的存在可为淋巴结阳性肺ADC患者提供重要的预后提示。
