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Lymph node ratio emerges as a pivotal prognostic determinant for cancer-specific survival amidst individuals diagnosed with stage N1 and N2 non-small cell lung carcinoma: A population-based retrospective cohort study.

作者信息

He Xiaowei, Huang Ying, Hu Tao

机构信息

Department of Pulmonary and Critical Care Medicine, Wuning County People's Hospital, Jiujiang City, Jiangxi Province, China.

Department of Pulmonary and Critical Care Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang City, Jiangxi Province, China.

出版信息

Medicine (Baltimore). 2025 Apr 18;104(16):e42202. doi: 10.1097/MD.0000000000042202.


DOI:10.1097/MD.0000000000042202
PMID:40258731
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12014090/
Abstract

Lung cancer is the leading cause of cancer-related deaths in the US, predominantly non-small cell lung cancer (NSCLC). Lymph node metastasis significantly impacts prognosis, yet current classification systems lack precision. Lymph node ratio (LNR), correlating metastatic to total lymph nodes, emerges as a superior prognostic tool. The study aimed to identify statistically validated LNR cutoffs and evaluate their prognostic significance in NSCLC patients, addressing limitations in the current tumor, node, and metastasis staging system. The study utilized data from the surveillance, epidemiology, and end results database (2010-2019) to analyze NSCLC patients undergoing tumor excision. Exclusions included those receiving chemotherapy or radiotherapy. Patients receiving chemotherapy or radiotherapy were excluded to isolate the independent impact of surgical lymph node retrieval on cancer-specific survival. The primary outcome focused on cancer-specific survival (CSS) stratified by LNR, with secondary analysis on N1/N2 NSCLC cases. X-tile software determined LNR cutoffs, categorizing patients into 3 groups. Descriptive statistics and Kaplan-Meier analysis were employed, along with multivariate Cox regression. Lower Akaike information criterion (AIC) values favored LNR models. Empower Stats and R software were utilized, with P < .05 indicating significance. Median CSS follow-up was 22 months, with 1265 NSCLC-related deaths. Lymph node retrieval averaged 11, with a median LNR of 0.15. X-tile analysis revealed LNR thresholds of 0.17 and 0.34, stratifying patients into low, medium, and high-risk groups. Kaplan-Meier show better differentiation when LNR is used as a predictor compared to N staging (LNR P < .0001 vs N stage P = .91). Multivariate Cox regression confirmed high LNR as an independent predictor of poorer CSS. A lower Akaike information criterion for LNR models highlighted its superior prognostic accuracy over N staging. This study demonstrates that the LNR is a superior prognostic indicator for N1 and N2 stage NSCLC compared to traditional N staging. By integrating metastatic burden and lymph node retrieval extent, LNR addresses key gaps in the tumor, node, and metastasis system and provides enhanced risk stratification. Clinicians can use LNR to identify high-risk patients who may benefit from intensified adjuvant therapies or tailored follow-up protocols. Further prospective studies are warranted to establish standardized LNR thresholds and validate its integration into clinical practice.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/2fc551e75ac5/medi-104-e42202-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/5948a31b0dc7/medi-104-e42202-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/b00a9bd5608c/medi-104-e42202-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/ab485ceb4015/medi-104-e42202-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/2fc551e75ac5/medi-104-e42202-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/5948a31b0dc7/medi-104-e42202-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/b00a9bd5608c/medi-104-e42202-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/ab485ceb4015/medi-104-e42202-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f876/12014090/2fc551e75ac5/medi-104-e42202-g004.jpg

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引用本文的文献

[1]
Neoadjuvant, Perioperative, and Adjuvant Immunotherapy in Early-Stage Surgically Resectable Non-Small Cell Lung Cancer: Updates and Future Perspectives.

Cancers (Basel). 2025-6-21

本文引用的文献

[1]
Comparative evaluation of negative lymph node count, positive lymph node count, and lymph node ratio in prognostication of survival following completely resection for non-small cell lung cancer: a multicenter population-based analysis.

Front Surg. 2024-12-9

[2]
Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after neoadjuvant immunochemotherapy.

BMC Gastroenterol. 2024-10-19

[3]
Number of involved nodal stations predicts survival in small cell lung cancer.

BMC Pulm Med. 2024-10-17

[4]
Prognostic Value of Lymph Node Ratio (LNR) in Patients with Postoperative N2 Feature in Non-Small Cell Lung Cancer (NSCLC).

J Clin Med. 2024-8-5

[5]
Role of Pathologic Single-Nodal and Multiple-Nodal Descriptors in Resected Non-Small Cell Lung Cancer.

Chest. 2024-11

[6]
A Prognostic Model Based on the Log Odds Ratio of Positive Lymph Nodes Predicts Prognosis of Patients with Rectal Cancer.

J Gastrointest Cancer. 2024-9

[7]
Lymph Node Ratio Enhances Predictive Value for Treatment Outcomes in Patients with Non-Small Cell Lung Cancer Undergoing Surgery: A Retrospective Cohort Study.

J Cancer. 2024-1-1

[8]
Long-Term Outcomes of Selected Patients with IIIA-N2 Non-small Cell Lung Cancer Receiving Upfront Surgical Resection.

Ann Surg Oncol. 2023-12

[9]
NCCN Guidelines® Insights: Non-Small Cell Lung Cancer, Version 2.2023.

J Natl Compr Canc Netw. 2023-4

[10]
Reaching multidisciplinary consensus on the management of non-bulky/non-infiltrative stage IIIA N2 non-small cell lung cancer.

Lung Cancer. 2023-3

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