Division of Pulmonology, Center for Lung Cancer, National Cancer Center, Goyang, Korea.
Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, Korea.
Chest. 2022 May;161(5):1382-1392. doi: 10.1016/j.chest.2021.11.032. Epub 2021 Dec 8.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the main procedure for mediastinal staging. However, long-term survival analyses according to clinical nodal stage diagnosed by EBUS-TBNA (eN stage) have not been reported. The value of EBUS-TBNA has not been assessed through an analysis of survival in false-negative EBUS-TBNA cases.
What is the prognostic impact of eN stage in non-small cell lung cancer (NSCLC)? What is the survival rate in false-negative EBUS-TBNA cases?
We retrospectively (January 2006 to December 2011) reviewed the medical records of patients with NSCLC who underwent EBUS-TBNA (± transesophageal approach) for initial staging (N = 1,089). Mediastinoscopy was not performed for EBUS-TBNA-negative cases. We performed 5-year survival analyses according to eN stage and treatment modality. Survival in false-negative EBUS-TBNA cases was compared with that in patients with pN0-1, including 941 non-EBUS-TBNA cases, during the same period.
Among the 1,089 patients undergoing EBUS-TBNA (eN0-1: n = 681; eN2: n = 314; eN3: n = 94), we observed significant differences in survival between the eN stages (eN0-1 vs eN2: P < .0001; eN2 vs eN3: P = .0118; estimated 5-year overall survival [5YOS] rate: eN0-1 = 57.4%, eN2 = 23.2%, eN3 = 12.8%). Surgery cases had better survival than nonsurgery cases among patients with eN0-1 and eN2 (eN0-1/surgery vs eN0-1/no surgery: P < .0001; eN2/surgery vs eN2/no surgery: P < .0001). Among the patients with eN0-1, there were 55 false-negative cases (eN0-1/pN2-3, pN2: n = 54; pN3: n = 1). The 5YOS rates of patients with pN0, pN1, and eN0-1/pN2-3 were 76.4%, 56.0%, and 56.4%, respectively. Patients with eN0-1/pN2-3 had worse survival than patients with pN0 (P = .0061), whereas there was no significant difference compared with patients with pN1 (P = .9191).
Long-term survival significantly differed according to eN stage in NSCLC, highlighting the importance of EBUS-TBNA in NSCLC staging. False-negative EBUS-TBNA cases had favorable survival which was similar to that of patients with pN1, which may provide a rationale for performing surgery after negative EBUS-TBNA results.
经支气管超声引导针吸活检术（EBUS-TBNA）是纵隔分期的主要程序。然而，根据 EBUS-TBNA 诊断的临床淋巴结分期（eN 分期）的长期生存分析尚未报道。EBUS-TBNA 的价值尚未通过对假阴性 EBUS-TBNA 病例的生存分析来评估。
eN 分期在非小细胞肺癌（NSCLC）中的预后影响是什么？假阴性 EBUS-TBNA 病例的生存率是多少？
我们回顾性地（2006 年 1 月至 2011 年 12 月）审查了接受 EBUS-TBNA（±经食管途径）进行初始分期的 NSCLC 患者的病历（n=1089）。对于 EBUS-TBNA 阴性病例，未进行纵隔镜检查。我们根据 eN 分期和治疗方式进行了 5 年生存分析。在同一时期，将假阴性 EBUS-TBNA 病例的生存情况与 pN0-1 患者（包括 941 例非 EBUS-TBNA 病例）进行了比较。
在接受 EBUS-TBNA 的 1089 例患者中（eN0-1：n=681；eN2：n=314；eN3：n=94），我们观察到 eN 分期之间的生存存在显著差异（eN0-1 与 eN2：P<0.0001；eN2 与 eN3：P=0.0118；估计 5 年总生存率[5YOS]率：eN0-1=57.4%，eN2=23.2%，eN3=12.8%）。在 eN0-1 和 eN2 患者中，手术病例的生存情况优于非手术病例（eN0-1/手术与 eN0-1/非手术：P<0.0001；eN2/手术与 eN2/非手术：P<0.0001）。在 eN0-1 患者中，有 55 例假阴性病例（eN0-1/pN2-3，pN2：n=54；pN3：n=1）。pN0、pN1 和 eN0-1/pN2-3 患者的 5YOS 率分别为 76.4%、56.0%和 56.4%。eN0-1/pN2-3 患者的生存情况比 pN0 患者差（P=0.0061），但与 pN1 患者无显著差异（P=0.9191）。
非小细胞肺癌的长期生存情况与 eN 分期明显相关，突出了 EBUS-TBNA 在 NSCLC 分期中的重要性。假阴性 EBUS-TBNA 病例的生存情况良好，与 pN1 患者相似，这可能为阴性 EBUS-TBNA 结果后进行手术提供了依据。
