Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Chest. 2021 Jun;159(6):2458-2469. doi: 10.1016/j.chest.2020.12.012. Epub 2020 Dec 19.
The eighth edition of nodal classification for non-small cell lung cancer (NSCLC) is defined only by the anatomical location of metastatic lymph nodes.
We sought to evaluate the prognostic significance and discriminatory capability of the number of involved nodal stations (nS) in a large Chinese cohort.
A total of 4,011 patients with NSCLC undergoing surgical resection between 2009 and 2013 were identified. The optimal cutoff values for nS classification were determined with X-tile software. Kaplan-Meier and multivariate Cox analysis were used to examine the prognostic performance of nS classification in comparison with location-based N classification. A decision curve analysis was performed to evaluate the standardized net benefit of nS classification in predicting prognosis.
All the patients were classified into four prognostically different subgroups according to the number of involved nodal stations: (1) nS0 (none positive), (2) nS1 (one involved station), (3) nS2 (two involved stations), and (4) nS ≥ 3 (three or more involved stations). The prognoses among all the neighboring categories of nS classification were statistically significantly different in terms of disease-free survival and overall survival. The multivariate Cox analysis demonstrated that nS was an independent prognostic factor of disease-free survival and overall survival. Patients with N1 or N2 stage disease could be divided into three prognostically different subgroups according to nS classification. However, the prognosis was similar between the N1 and N2 subgroups when patients were staged in the same nS category. The decision curve analysis showed that nS classification tended to have a higher predictive capability than location-based N classification.
The nS classification could be used to provide a more accurate prognosis for patients with resected NSCLC. The nS is worth taking into consideration when defining nodal category in the forthcoming ninth edition of the staging system.
第八版非小细胞肺癌（NSCLC）的淋巴结分类仅基于转移性淋巴结的解剖位置。
我们试图在中国的大样本队列中评估受累淋巴结站数（nS）的预后意义和区分能力。
共纳入 2009 年至 2013 年间接受手术切除的 4011 例 NSCLC 患者。使用 X-tile 软件确定 nS 分类的最佳截断值。使用 Kaplan-Meier 和多变量 Cox 分析比较 nS 分类与基于位置的 N 分类在预后中的表现。通过决策曲线分析评估 nS 分类预测预后的标准化净获益。
所有患者根据受累淋巴结站数分为四个具有不同预后的亚组：（1）nS0（无阳性），（2）nS1（一个受累站），（3）nS2（两个受累站），（4）nS≥3（三个或更多受累站）。在无病生存和总生存方面，所有相邻 nS 分类的预后均有统计学差异。多变量 Cox 分析表明，nS 是无病生存和总生存的独立预后因素。N1 或 N2 期患者可根据 nS 分类分为三个具有不同预后的亚组。然而，当患者在同一 nS 类别中分期时，N1 和 N2 亚组的预后相似。决策曲线分析表明，nS 分类比基于位置的 N 分类具有更高的预测能力。
nS 分类可用于为接受 NSCLC 切除术的患者提供更准确的预后。在即将发布的第九版分期系统中，nS 值得考虑用于定义淋巴结类别。
