Shen Xinchen, Chen Tao, Yu Juemin, Wen Jialiang, Ji Haoran, Guo Zihan, Yang Minglei, Yu Bentong, Song Yongxiang, Chen Yangchun, Zhao Long, Hou Likun, Ren Longbing, Zhao Deping, She Yunlang, Chen Chang, Xie Dong, Deng Jiajun
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Ningbo No.2 Hospital, Chinese Academy of Sciences, Zhejiang, China.
Eur J Nucl Med Mol Imaging. 2025 Sep 23. doi: 10.1007/s00259-025-07544-0.
To elucidate the potential reasons for the favourable prognosis of positron emission tomography/computed tomography (PET/CT)-defined occult N2 metastasis and its survival effect in the context of the newly proposed ninth edition N descriptors.
A total of 3565 patients who underwent preoperative PET/CT and surgical resection for non-small cell lung cancer were retrospectively included. Survival analysis was conducted using the Kaplan-Meier method and Cox proportional hazards model.
The incidence of single-station involvement was significantly higher (p < .001) in occult N2 metastasis (117/191, 61.3%) compared to evident N2 metastasis (83/198, 41.9%). The survival rates of patients with occult N2a (single-station N2 involvement) and occult N2b (multiple-station N2 involvement) were comparable to those of patients with clinically evident N2a and N2b, respectively (adjusted p >.20 for all). Conversely, single-station involvement was associated with a markedly superior prognosis than multiple-station involvement, whether for patients with occult N2 metastasis (5-year overall survival [OS]: 62.7% vs 50.1%, adjusted p = .04) or patients with clinically evident N2 metastasis (5-year OS: 50.3% vs 36.2%, adjusted p = .03). Cox regression analysis of the pathological N2 population further indicated that multiple-station involvement was a more robust prognostic factor than occult lymph node metastasis.
The favourable prognosis of PET/CT-defined occult N2 metastasis may be attributed to the discrepancy in prognosis and proportion between occult N2a and clinically evident N2b. This external validation provided substantial evidence supporting the reasonableness and robustness of the newly proposed ninth edition N descriptors.
在新提出的第九版N描述符的背景下，阐明正电子发射断层扫描/计算机断层扫描（PET/CT）定义的隐匿性N2转移预后良好的潜在原因及其生存效应。
回顾性纳入3565例行非小细胞肺癌术前PET/CT检查及手术切除的患者。采用Kaplan-Meier法和Cox比例风险模型进行生存分析。
隐匿性N2转移（117/191，61.3%）中单站受累的发生率显著高于明显N2转移（83/198，41.9%）（p <.001）。隐匿性N2a（单站N2受累）和隐匿性N2b（多站N2受累）患者的生存率分别与临床明显N2a和N2b患者的生存率相当（所有调整后p>.20）。相反，无论是隐匿性N2转移患者（5年总生存率[OS]：62.7%对50.1%，调整后p =.04）还是临床明显N2转移患者（5年OS：50.3%对36.2%，调整后p =.03），单站受累的预后均明显优于多站受累。对病理N2人群的Cox回归分析进一步表明，多站受累比隐匿性淋巴结转移是更强的预后因素。
PET/CT定义的隐匿性N2转移预后良好可能归因于隐匿性N2a与临床明显N2b在预后和比例上的差异。这项外部验证提供了大量证据，支持新提出的第九版N描述符的合理性和稳健性。
