Abstract
BackgroundThe aim of this study was to investigate whether the lymph node ratio (LNR) was associated with the prognosis of patients, who underwent surgery for pathological N2 non-small cell lung cancer (NSCLC).MethodsA total of 182 patients were diagnosed with pathological N2 disease and underwent complete resection surgeries with systematic lymphadenectomies. We counted the number of positives and removed lymph nodes to calculate a ratio between them (LNR). We also investigated the association between skip mediastinal lymph node metastasis and survival.ResultsUnivariate analysis of survival in patients with N2 NSCLC showed that the T factor, clinical N factor, and LNR were significant prognostic factors. Multivariate analyses showed that the clinical N stage and LNR were significant independent prognostic factors for patients with pathological N2 NSCLC. Patients with a clinical lymph node status of 0 (cN0) and LNR ≤0.22 showed a significantly higher survival rate than patients with a cN1-2 and LNR ≥0.22 and 5-year survival rates were 47.1 and 10.3%, respectively (p < 0.0001).ConclusionsLNR is an important prognostic factor for poor outcome following surgery in patients with N2 disease. The combination of the LNR and cN status provides a valuable prognostic tool.
Highlights
The aim of this study was to investigate whether the lymph node ratio (LNR) was associated with the prognosis of patients, who underwent surgery for pathological N2 non-small cell lung cancer (NSCLC)
Since 2004, we introduced fluoro-deoxyglucosepositron emission tomography (FDG-PET), which was used as a reference and performed on 48 patients
A univariate analysis of survival in patients with N2 NSCLC showed that the T factor (T1 or 2 vs. T3, p < 0.0001), Clinical node (cN) factor (N0 vs. N1 o r2, p = 0.0094), and LNR (≤0.22 vs. >0.22, p = 0.0056) were significant prognostic factors (Table 2)
Summary
The aim of this study was to investigate whether the lymph node ratio (LNR) was associated with the prognosis of patients, who underwent surgery for pathological N2 non-small cell lung cancer (NSCLC). Non-small cell lung cancer (NSCLC) featuring clinical mediastinal disease is not often amenable to complete resection. The survival range among patients with stage III NSCLC is associated with various prognostic factors, suggesting that patients at the N2 stage are a heterogeneous group [1, 2]. The heterogeneity of NSCLC involves multiple factors, including preoperative detection, neoadjuvant therapy susceptibility, clinically unsuspected N2 disease (the presence of ipsilateral mediastinal nodal metastases), and the level or site and number, or both, of involved mediastinal lymph nodes [1, 3]. We investigated the correlation between LNR and prognosis in patients with pathological N2 NSCLC
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