Abstract
PurposeWe investigated the correlation between the number of examined lymph nodes (ELNs) and correct staging and long-term survival in non–small-cell lung cancer (NSCLC) by using large databases and determined the minimal threshold for the ELN count.MethodsData from a Chinese multi-institutional registry and the US SEER database on stage I to IIIA resected NSCLC (2001 to 2008) were analyzed for the relationship between the ELN count and stage migration and overall survival (OS) by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. The selected cut point was validated with the SEER 2009 cohort.ResultsAlthough the distribution of ELN count differed between the Chinese registry (n = 5,706) and the SEER database (n = 38,806; median, 15 versus seven, respectively), both cohorts exhibited significantly proportional increases from N0 to N1 and N2 disease (SEER OR, 1.038; China OR, 1.012; both P < .001) and serial improvements in OS (N0 disease: SEER HR, 0.986; China HR, 0.981; both P < .001; N1 and N2 disease: SEER HR, 0.989; China HR, 0.984; both P < .001) as the ELN count increased after controlling for confounders. Cut point analysis showed a threshold ELN count of 16 in patients with declared node-negative disease, which were examined in the derivation cohorts (SEER 2001 to 2008 HR, 0.830; China HR, 0.738) and validated in the SEER 2009 cohort (HR, 0.837).ConclusionA greater number of ELNs is associated with more-accurate node staging and better long-term survival of resected NSCLC. We recommend 16 ELNs as the cut point for evaluating the quality of LN examination or prognostic stratification postoperatively for patients with declared node-negative disease.
Highlights
Lung cancer is the leading cause of cancer-related mortality worldwide, with approximately 85% of patients having non–small-cell lung cancer (NSCLC).[1]
We investigated the correlation between the number of examined lymph nodes (ELNs) and correct staging and long-term survival in non–small-cell lung cancer (NSCLC) by using large databases and determined the minimal threshold for the ELN count
Results the distribution of ELN count differed between the Chinese registry (n = 5,706) and the SEER database (n = 38,806; median, 15 versus seven, respectively), both cohorts exhibited significantly proportional increases from N0 to N1 and N2 disease (SEER odds ratio (OR), 1.038; China OR, 1.012; both P, .001) and serial improvements in overall survival (OS) (N0 disease: SEER hazard ratio (HR), 0.986; China HR, 0.981; both P, .001; N1 and N2 disease: SEER HR, 0.989; China HR, 0.984; both P, .001) as the ELN count increased after controlling for confounders
Summary
Lung cancer is the leading cause of cancer-related mortality worldwide, with approximately 85% of patients having non–small-cell lung cancer (NSCLC).[1] For early-stage resectable NSCLC, radical surgical resection remains the standard of care. Patients with positive lymph node (LN) metastasis have a higher risk of disease recurrence; LN involvement is one of the most important determinants for both prognosis and decisions about treatment strategy in patients with resectable NSCLC. LN sampling or dissection plays an important role in precise nodal staging by identifying LN involvement and determining the extent of disease and in the therapeutic effect of potential LN metastatic lesion clearance. Adjuvant chemotherapy is recommended for patients with NSCLC who have any sign of LN metastasis,[3] and the benefits of adjuvant
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