Feasibility of nodal classification for non-small cell lung cancer by merging current N categories with the number of involved lymph node stations.

Abstract

IntroductionThe aim of this study was to assess the prognoses of patients with non‐small cell lung cancer (NSCLC) according to the current nodal (N) categories of the tumor, node and metastasis (TNM) classification and the number of involved lymph node stations.MethodsFive hundred and seventy patients with NSCLC underwent surgery from 1 January 2005 to 31 December 2009 and were analysed retrospectively. Postoperative overall survival was analysed according to two nodal classifications: the current N0, N1, N2 and N3 categories and those based on the number of involved nodal stations: N0, N1a (single N1), N1b (multiple N1), N2a1 (single N2 without N1), N2a2 (single N2 with N1), N2b1 (multiple N2 without N1) and N2b2 (multiple N2 with N1).ResultsFive‐year survival rates were 76.1%, 53.4% and 26.3% for N0, N1 and N2, respectively (P < 0.001). When survival was analysed by the number of involved nodal stations, the groups with significant differences were maintained; otherwise, they were merged, and new codes were assigned as follows for exploratory analyses: NA (N0), NB (N1a), NC (N1b, N2a (i.e., N2a1 and N2a2) and N2b1) and ND (N2b2). Five‐year survival rates were 76.1%, 60.0%, 39.1%, and 11.4% for NA, NB, NC and ND, respectively, and there were significant differences among them. This N classification was an independent prognostic factor in multivariate analyses.ConclusionPending prospective and international validation, it is practical to merge the current N categories with the number of involved lymph node stations when evaluating the postoperative prognosis of NSCLC patients.