Ruiter Julianne, de Langen Adrianus, Monkhorst Kim, Veenhof Alexander, Klomp Houke, Smit Jasper, Smit Egbert, Damhuis Ronald, Hartemink Koen
Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, the Netherlands.
Acta Chir Belg. 2024 Oct;124(5):387-395. doi: 10.1080/00015458.2024.2322243. Epub 2024 Feb 28.
Previous studies investigating whether metastatic lymph node count is a relevant prognostic factor in pathological N1 non-small cell lung cancer (NSCLC), showed conflicting results. Hypothesizing that outcome may also be related to histological features, we determined the prognostic impact of single versus multiple metastatic lymph nodes in different histological subtypes for patients with stage II-N1 NSCLC.
We performed a retrospective cohort study using data from the Netherlands Cancer Registry, including patients treated with a surgical resection for stage II-N1 NSCLC (TNM 7th edition) in 2010-2016. Overall survival (OS) was assessed for patients with single (pN1a) and multiple (pN1b) metastatic nodes. Using multivariable analysis, we compared OS between pN1a and pN1b in different histological subtypes.
After complete resection of histologically proven stage II-N1 NSCLC, 1309 patients were analyzed, comprising 871 patients with pN1a and 438 with pN1b. The median number of pathologically examined nodes (N1 + N2) was 9 (interquartile range 6-13). Five-year OS was 53% for pN1a versus 51% for pN1b. In multivariable analysis, OS was significantly different between pN1a and pN1b (HR 1.19, 95% CI 1.01-1.40). When stratifying for histology, the prognostic impact of pN1a/b was only observed in adenocarcinoma patients (HR 1.44, 95% CI 1.15-1.81).
Among patients with stage II-N1 adenocarcinoma, the presence of multiple metastatic nodes had a significant impact on survival, which was not observed for other histological subtypes. If further refinement as to lymph node count will be considered for incorporation into a new staging system, evaluation of the role of histology is recommended.
既往研究探讨转移性淋巴结数量是否为病理N1期非小细胞肺癌（NSCLC）的相关预后因素，结果相互矛盾。鉴于预后可能还与组织学特征有关，我们确定了II - N1期NSCLC患者不同组织学亚型中单个与多个转移性淋巴结的预后影响。
我们进行了一项回顾性队列研究，使用荷兰癌症登记处的数据，纳入2010 - 2016年接受II - N1期NSCLC（TNM第7版）手术切除的患者。评估了单个（pN1a）和多个（pN1b）转移性淋巴结患者的总生存期（OS）。通过多变量分析，我们比较了不同组织学亚型中pN1a和pN1b患者的OS。
在组织学确诊的II - N1期NSCLC完全切除术后，分析了1309例患者，其中871例为pN1a患者，438例为pN1b患者。病理检查淋巴结（N1 + N2）的中位数为9（四分位间距6 - 13）。pN1a患者的5年OS为53%，pN1b患者为51%。在多变量分析中，pN1a和pN1b患者的OS有显著差异（HR 1.19，95%CI 1.01 - 1.40）。按组织学分层时，pN1a/b的预后影响仅在腺癌患者中观察到（HR 1.44，95%CI 1.15 - 1.81）。
在II - N1期腺癌患者中，多个转移性淋巴结的存在对生存有显著影响，其他组织学亚型未观察到这种情况。如果考虑进一步细化淋巴结数量以纳入新的分期系统，建议评估组织学的作用。
