Feng Shoujie, Liu Xiangming, Huang Bing, Shi Jing, Zhang Hao
Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Thoracic Surgery Laboratory, Xuzhou Medical University, 84 West Huaihai Road, Xuzhou, China.
Front Surg. 2022 Jun 9;9:909810. doi: 10.3389/fsurg.2022.909810. eCollection 2022.
The effects of examined lymph nodes (LNs) and lymph node ratio (LNR) on pN classification and the prognosis are unclear in lung adenosquamous carcinoma (ASC) patients. Thus, this study aimed to investigate the significance of LNs and LNR in the prognosis of ASC and the impact of the abovementioned factors on the pN classification.
Patients diagnosed with pathological stage T1-4N0-2M0 ASC from the Surveillance Epidemiology and End Results database were included in the study. The primary clinical endpoint was cancer-specific survival (CSS). The optimal cutoff values of the LNs and LNR were determined. An LN indicator, including pN0 #LNs ≤9, pN0 #LNs >9, pN #LNR ≤0.53, and pN #LNR > 0.53, was developed. Concordance index (C-index) was used to compare the prognostic predictive ability between N classification and LN indicator. The univariable and multivariable Cox regression analyses were used in this study.
The cohort of 1,416 patients were included in the study. The level of LNs stratified the patients without metastasis of lymph nodes (pN0 #LNs ≤9 vs. pN0 #LNs >9, unadjusted hazard ratio [HR] = 1.255, = 0.037). Two groups based on the cutoff value of LNR differentiated prognosis of patients with metastasis of lymph nodes (pN #LNR >0.53 vs. pN #LNR ≤0.53, unadjusted HR = 1.703, = 0.001). The LN indicator had a much better predictive ability over N classification in this cohort (LN indicator: C-index = 0.615; N classification: C-index = 0.602, = 0.001).
We explored clinicopathological factors affecting prognosis in resected lung ASC patients. Besides, the LN indicator was confirmed to be played an essential role in affecting the survival rate in ASC patients. The high-level LNs or low-level LNR might be corelated to improved survival outcomes.
在肺腺鳞癌（ASC）患者中，送检淋巴结（LNs）及淋巴结比率（LNR）对pN分期及预后的影响尚不清楚。因此，本研究旨在探讨LNs和LNR在ASC预后中的意义以及上述因素对pN分期的影响。
本研究纳入了监测、流行病学和最终结果数据库中诊断为病理分期T1 - 4N0 - 2M0 ASC的患者。主要临床终点为癌症特异性生存（CSS）。确定了LNs和LNR的最佳截断值。制定了一个LN指标，包括pN0 #LNs≤9、pN0 #LNs>9、pN #LNR≤0.53和pN #LNR>0.53。一致性指数（C-index）用于比较N分期与LN指标之间的预后预测能力。本研究采用单变量和多变量Cox回归分析。
本研究共纳入1416例患者。LNs水平对无淋巴结转移患者进行了分层（pN0 #LNs≤9与pN0 #LNs>9，未调整风险比[HR]=1.255，P = 0.037）。基于LNR截断值的两组区分了有淋巴结转移患者的预后（pN #LNR>0.53与pN #LNR≤0.53，未调整HR = 1.703，P = 0.001）。在该队列中，LN指标比N分期具有更好的预测能力（LN指标：C-index = 0.615；N分期：C-index = 0.602，P = 0.001）。
我们探讨了影响肺ASC切除患者预后的临床病理因素。此外，证实LN指标在影响ASC患者生存率方面起着重要作用。高水平的LNs或低水平的LNR可能与改善生存结果相关。
