Chen Zhangxuan, Zhang Qingfeng, Xiong Lei, Meng Yunchang, Yao Yang, Wu Ranpu, Li Xinjing, Wang Bingxue, Sun Jiajie, Gong Yanzhuo, Liu Hongbing, Shen Yi
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Department of Cardiothoracic Surgery, Jinling Hospital, Jinling Clinical Medical School, Nanjing Medical University, Nanjing, China.
J Thorac Dis. 2025 Jul 31;17(7):4501-4511. doi: 10.21037/jtd-2024-2201. Epub 2025 Jul 8.
Current nodal classification inadequately predicts outcomes for advanced non-small cell lung cancer (NSCLC) patients. We investigated whether metastatic lymph node characteristics could improve prognostic accuracy.
We retrospectively analyzed 339 patients with advanced NSCLC who received immunotherapy as first-line treatment. Lymph node imaging was performed using computed tomography (CT), and the X-tile software was employed to determine optimal cutoff values for lymph node size and number. Prognostic factors were assessed using Kaplan-Meier survival curves and multivariate Cox regression analysis. The predictive accuracy of various N-staging was evaluated through time-dependent receiver operating characteristic (ROC) curves.
The optimal cutoff values for lymph node size and number were 1.60 cm and 3, respectively. Kaplan-Meier analysis indicated that size, number, and fusion of metastatic lymph nodes were associated with worse overall survival (OS) in advanced NSCLC patients {hazard ratio (HR) [95% confidence interval (CI)]: 2.179 (1.432-3.316), 1.859 (1.226-2.821), and 3.635 (1.796-7.358)}. Multivariate Cox regression analysis identified lymph node size [HR (95% CI): 6.21 (1.19-32.25)] and fusion [HR (95% CI): 3.20 (1.32-7.75)] as independent prognostic factors for OS. Incorporating lymph node size into the conventional N-staging system improved prognostic accuracy, with a 3-year area under the curve (AUC) of 0.651 (95% CI: 0.535-0.767).
Lymph node size serves as a valuable indicator of tumor invasion and can enhance the existing N-staging system for more accurate prognosis prediction for more accurate prognosis prediction in advanced NSCLC.
目前的淋巴结分类不足以预测晚期非小细胞肺癌（NSCLC）患者的预后。我们研究了转移性淋巴结特征是否能提高预后准确性。
我们回顾性分析了339例接受免疫治疗作为一线治疗的晚期NSCLC患者。使用计算机断层扫描（CT）进行淋巴结成像，并采用X-tile软件确定淋巴结大小和数量的最佳截断值。使用Kaplan-Meier生存曲线和多变量Cox回归分析评估预后因素。通过时间依赖性受试者工作特征（ROC）曲线评估各种N分期的预测准确性。
淋巴结大小和数量的最佳截断值分别为1.60 cm和3。Kaplan-Meier分析表明，转移性淋巴结的大小、数量和融合与晚期NSCLC患者较差的总生存期（OS）相关{风险比（HR）[95%置信区间（CI）]：2.179（1.432-3.316）、1.859（1.226-2.821）和3.635（1.796-7.358）}。多变量Cox回归分析确定淋巴结大小[HR（95%CI）：6.21（1.19-32.25）]和融合[HR（95%CI）：3.20（1.32-7.75）]是OS的独立预后因素。将淋巴结大小纳入传统N分期系统可提高预后准确性，3年曲线下面积（AUC）为0.651（95%CI：0.535-0.767）。
淋巴结大小是肿瘤侵袭的重要指标，可增强现有的N分期系统，以便更准确地预测晚期NSCLC的预后。
