Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Chest. 2024 Nov;166(5):1218-1228. doi: 10.1016/j.chest.2024.06.3797. Epub 2024 Jul 14.
The eighth edition of lung cancer nodal staging assignment includes the location of lymph node metastasis, but does not include single-nodal and multiple-nodal descriptors.
Do the single-nodal and multiple-nodal statuses stratify the prognosis of patients with non-small cell lung cancer (NSCLC)?
Using the National Cancer Database, we analyzed patients with pathologically staged N1 and N2 NSCLC. Nodal descriptors were classified into pathological single N1 (pSingle-N1), pathological multiple N1 (pMulti-N1), pathological single N2 (pSingle-N2), and pathological multiple N2 (pMulti-N2). Survival analysis was performed using the Kaplan-Meier method and multivariable Cox regression models.
In the general analysis cohort, 24,531, 22,256, 8,528, and 21,949 patients with NSCLC demonstrated pSingle-N1, pMulti-N1, pSingle-N2, and pMulti-N2 disease, respectively. Patients with pMulti-N1 and pMulti-N2 disease showed a shorter survival than those with pSingle-N1 and pSingle-N2 disease, respectively (hazard ratio, 1.22 [P < .0001] for N1 and 1.39 [P < .0001] for N2). After adjusting age, sex, and histologic findings, the hazard ratio for pSingle-N2 compared with pMulti-N1 disease was 1.05 (P = .0031). Patients with pN1 disease were categorized by metastatic lymph node count (1, 2, 3, ≥ 4), showing significant prognostic differences among groups (P < .0001). In the sensitivity analysis cohort (limited to R0 resection, lobectomy, or more; survival ≥ 30 days; ≥ 10 examined lymph nodes; and without neoadjuvant therapy; n = 34,904) and the external validation cohort (n = 708), analyses supported these results.
Patients with NSCLC with one metastatic lymph node, whether in N1 or N2 stations, showed better survival than those with more than one lymph node involved. Patients with NSCLC with a single-skip N2 lymph node metastasis showed survival similar to patients with multiple N1 lymph nodes, and the number of lymph nodes involved in N1 resections up to four or more was sequentially prognostic.
第八版肺癌淋巴结分期方案包括淋巴结转移的位置，但不包括单个淋巴结和多个淋巴结的描述。
单个淋巴结和多个淋巴结状态是否能分层非小细胞肺癌（NSCLC）患者的预后？
利用国家癌症数据库，我们分析了病理分期为 N1 和 N2 的 NSCLC 患者。淋巴结描述符分为病理单个 N1（pSingle-N1）、病理多个 N1（pMulti-N1）、病理单个 N2（pSingle-N2）和病理多个 N2（pMulti-N2）。使用 Kaplan-Meier 方法和多变量 Cox 回归模型进行生存分析。
在一般分析队列中，分别有 24531、22256、8528 和 21949 例 NSCLC 患者为 pSingle-N1、pMulti-N1、pSingle-N2 和 pMulti-N2 疾病。与 pSingle-N1 和 pSingle-N2 疾病相比，pMulti-N1 和 pMulti-N2 疾病的患者生存时间更短（N1 危险比为 1.22 [P <.0001]，N2 为 1.39 [P <.0001]）。调整年龄、性别和组织学发现后，与 pMulti-N1 疾病相比，pSingle-N2 疾病的危险比为 1.05（P =.0031）。N1 疾病患者根据转移淋巴结计数（1、2、3、≥4）进行分类，各组之间存在显著的预后差异（P <.0001）。在敏感性分析队列（仅限于 R0 切除、肺叶切除术或以上；生存时间≥30 天；≥10 个检查淋巴结；无新辅助治疗；n = 34904）和外部验证队列（n = 708）中，分析结果支持这些结果。
有一个转移淋巴结的 NSCLC 患者，无论是 N1 还是 N2 部位，其生存时间均优于有多个淋巴结受累的患者。有单个跳跃性 N2 淋巴结转移的 NSCLC 患者的生存时间与多个 N1 淋巴结受累的患者相似，N1 切除中受累淋巴结的数量增加至四个或更多与预后依次相关。
