Aksoy Yunus, Çıtak Necati, Obuz Çiğdem, Metin Muzaffer, Sayar Adnan
Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
Interact Cardiovasc Thorac Surg. 2021 Oct 4;33(4):541-549. doi: 10.1093/icvts/ivab119.
The newly proposed N subclassification (new-N) was compared with the combined anatomical location and ratio of the number of metastatic lymph nodes to the total number of resected lymph nodes (anatomic-LNR) in terms of prognosis in resected lung cancer patients.
Between 2005 and 2018, 961 patients who underwent lung cancer resection were catergorized into the pN1-single (N1a; n = 281), pN1-multiple (N1b; n = 182), pN2-single with skip metastasis (N2a1; n = 116), pN2-single with N1 metastasis (N2a2; n = 222) and pN2-multiple (N2b; n = 160) groups based on new-N. The optimal cut-off points for survival in pN1 and pN2 patients were determined using the best sensitivity and specificity scores, calculated using receiver operating characteristic analysis.
The difference in survival between N1a and N1b patients was statistically significant (P = 0.001), but there was no significant difference in the survival rates of N1b and N2a1 (P = 0.52). The survival curves for N2a1 and N2a2 patients almost overlapped (P = 0.143). N2a2 patients showed a better survival rate than N2b patients, with no significant difference (P = 0.132). The cut-off points for LNR were 0.10 and 0.25 for pN1 and pN2 patients, respectively, according to receiver operating characteristic analysis for survival. Based on receiver operating characteristic analysis, pN patients were categorized into the N1-lowLNR (n = 232), N1-highLNR (n = 231), N2-lowLNR (n = 266) and N2-highLNR (n = 232) groups. The 5-year survival rate was 62.9%, 49.8%, 41.1% and 27.1% for N1-lowLNR, N1-highLNR, N2-lowLNR and N2-highLNR, respectively (P < 0.001).
LowLNR is associated with better survival than highLNR in resected lung cancer patients. Anatomic-LNR shows a high discriminatory power for prognosis.
比较新提出的N亚分类（新N）与切除的肺癌患者的转移淋巴结数量与切除的淋巴结总数之比联合解剖位置（解剖学LNR）在预后方面的差异。
2005年至2018年间，961例行肺癌切除术的患者根据新N被分为pN1单站（N1a；n = 281）、pN1多站（N1b；n = 182）、pN2单站伴跳跃转移（N2a1；n = 116）、pN2单站伴N1转移（N2a2；n = 222）和pN2多站（N2b；n = 160）组。使用受试者工作特征分析计算的最佳敏感性和特异性分数确定pN1和pN2患者生存的最佳截断点。
N1a和N1b患者的生存率差异具有统计学意义（P = 0.001），但N1b和N2a1患者的生存率无显著差异（P = 0.52）。N2a1和N2a2患者的生存曲线几乎重叠（P = 0.143）。N2a2患者的生存率高于N2b患者，但差异不显著（P = 0.132）。根据生存的受试者工作特征分析，pN1和pN2患者的LNR截断点分别为0.10和0.25。根据受试者工作特征分析，pN患者被分为N1低LNR（n = 232）、N1高LNR（n = 231）、N2低LNR（n = 266）和N2高LNR（n = 232）组。N1低LNR、N1高LNR、N2低LNR和N2高LNR组的5年生存率分别为62.9%、49.8%、41.1%和
