Department of Internal Medicine, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital.
Chongqing Bishan Hospital of Traditional Chinese Medicine.
Am J Clin Oncol. 2022 Dec 1;45(12):506-513. doi: 10.1097/COC.0000000000000958. Epub 2022 Nov 15.
We aimed to evaluate the prognostic impact of the number of examined lymph nodes (ELNs) in resected early‑stage pulmonary typical carcinoid tumors (TC).
Patients who underwent sublobar resection and lobectomy for stage T1N0M0 TC between 2004 and 2016 were identified from the Surveillance, Epidemiology, and End Results database and enrolled in the ELNs≥4 or ELNs<4 groups (optimal cutoff using X-tile). Propensity score matching balanced baseline intergroup characteristics. Kaplan-Meier curve and log-rank test were used to calculate and compare overall survival (OS) rates. Cox proportional hazard model analysis was used to identify independent prognostic factors.
Among 2234 participants, 961 (43.02%) and 1273 (56.98%) had ELNs <4 and ≥4, respectively. The 5-year OS was significantly higher in the ELNs≥4, compared with ELNs<4, group, both before and after propensity score matching (95.41% vs. 89.71%, P<0.001 and 95.24% vs. 90.28%, P=0.004), respectively. Surgical subgroup analysis confirmed this survival trend in the lobectomy and sublobar resection groups. Tumor size-based subgroup analysis revealed superior OS with ELNs≥4 than ELNs<4 for tumors measuring 1.1-3.0 cm but not for tumors <1.0 cm. Multivariate Cox analysis showed that ELN≥4 contributed to improved OS.
The higher the ELNs, the greater the long-term survival rate in patients with early‑stage TC. Therefore, we recommend at least 4 ELNs as the cutoff value for evaluating the prognosis of early‑stage TCs, especially for patients with a tumor size of 1.1 to 3.0 cm.
本研究旨在评估在接受解剖性肺段切除或肺叶切除治疗的 T1N0M0 期肺典型类癌（TC）患者中，清扫淋巴结数目（ELNs）对预后的影响。
本研究回顾性分析了 2004 年至 2016 年间接受亚肺叶切除术和肺叶切除术治疗的 T1N0M0 TC 患者的 Surveillance，Epidemiology，and End Results（SEER）数据库，将患者分为 ELNs≥4 或 ELNs<4 组（使用 X-tile 软件确定最佳截断值）。采用倾向评分匹配法平衡组间基线特征。采用 Kaplan-Meier 曲线和对数秩检验比较总生存（OS）率，采用 Cox 比例风险模型分析独立预后因素。
在 2234 例患者中，961 例（43.02%）和 1273 例（56.98%）的 ELNs<4 和 ELNs≥4，分别。在未进行和进行倾向评分匹配后，ELNs≥4 组的 5 年 OS 均显著高于 ELNs<4 组（95.41%比 89.71%，P<0.001；95.24%比 90.28%，P=0.004）。手术亚组分析也证实了肺叶切除和肺段切除组的这种生存趋势。基于肿瘤大小的亚组分析显示，对于直径为 1.1-3.0cm 的肿瘤，ELNs≥4 比 ELNs<4 有更好的 OS，但对于直径<1.0cm 的肿瘤则不然。多因素 Cox 分析显示，ELN≥4 与 OS 改善有关。
ELNs 越多，早期 TC 患者的长期生存率越高。因此，我们建议至少 4 枚 ELNs 作为评估早期 TC 患者预后的截断值，特别是对于肿瘤直径为 1.1-3.0cm 的患者。
