Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China.
Ann Surg Oncol. 2021 Aug;28(8):4510-4516. doi: 10.1245/s10434-020-09461-y. Epub 2021 Jan 2.
The International Association for the Study of Lung Cancer (IASLC) N classifications, which depend on the location and involvement of the lymph nodes, provide accurate prognoses. This study validated the efficiency of classifications using a single-institution dataset and proposed a modified system based on 5-level N1 node dissection.
From January 2005 to December 2014, 1851 patients with completely resected non-small cell lung cancer were reviewed. According to the IASLC recommendations, N1 is further subdivided into N1a (single) and N1b (multiple), N2 is divided into N2a1 (single station without N1), N2a2 (single station with N1), and N2b (multiple station). Additionally, we evaluated dividing N0 into N0a (with level 13/14 examination) and N0b (without level 13/14 examination), and N1 into N1a* (only level 13/14 positive) and N1b* (level 10-12 positive). Overall survival was also compared.
Multivariate analysis showed that the N classifications recommended by the IASLC and those proposed and evaluated by this study could both significantly predict the prognoses of patients (p < 0.001, respectively). There was no significant difference in survival between N1b and N1a (hazard ratio [HR] 1.049, p = 0.83) and N2a1 and N1b (HR 1.314, p = 0.261); however, there were significant differences between N0a and N0b (HR 1.778, p < 0.001) and N1a* and N1b* (HR 2.014, p = 0.019). The survival curve of N1a* overlapped N0b (HR 0.997, p = 0.991), and N2a1 overlapped N1b* (HR 0.842, p = 0.444).
More detailed nodal information is required to facilitate future revisions of N staging.
国际肺癌研究协会（IASLC）的 N 分类法依赖于淋巴结的位置和累及情况，可提供准确的预后。本研究使用单机构数据集验证了分类法的效率，并提出了一种基于 5 级 N1 淋巴结清扫的改良系统。
从 2005 年 1 月至 2014 年 12 月，共回顾了 1851 例完全切除的非小细胞肺癌患者。根据 IASLC 的建议，N1 进一步细分为 N1a（单个）和 N1b（多个），N2 分为 N2a1（无 N1 的单个部位）、N2a2（有 N1 的单个部位）和 N2b（多个部位）。此外，我们评估了将 N0 分为 N0a（有 13/14 水平检查）和 N0b（无 13/14 水平检查），以及将 N1 分为 N1a*（仅 13/14 阳性）和 N1b*（10-12 阳性）。还比较了总生存率。
多变量分析显示，IASLC 推荐的 N 分类法和本研究提出和评估的分类法都能显著预测患者的预后（p<0.001）。N1b 和 N1a（风险比 [HR]1.049，p=0.83）和 N2a1 和 N1b（HR1.314，p=0.261）之间的生存无显著差异；然而，N0a 和 N0b（HR1.778，p<0.001）和 N1a和 N1b（HR2.014，p=0.019）之间存在显著差异。N1a的生存曲线与 N0b 重叠（HR0.997，p=0.991），N2a1 与 N1b重叠（HR0.842，p=0.444）。
需要更详细的淋巴结信息来促进 N 分期的未来修订。
