Prognostic and Predictive Effects of Positive Lymph Node Number or Ratio in NSCLC

Nan Ding,Jiajun Du,Qi Liu,Xiangwei Zhang,Cuicui Huang,Zhaofei Pang,Yufan Yang

doi:10.1038/s41598-017-00619-5

Nan Ding, Jiajun Du + Show 5 more

Open Access

https://doi.org/10.1038/s41598-017-00619-5

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Abstract

In the eighth TNM staging system proposal for NSCLC recently, classification of N stage is based on anatomical position of positive lymph nodes. We aimed to expand the sample volume to identify the value of positive lymph node number or ratio in prognosis and predictive effect for postoperative radiation. Clinicopathological characters of 109026 NSCLC patients were collected from the SEER Database. Kaplan-Meier curves and cox regression methods were used for survival analysis. Compared with positive lymph node number equal to 0, 1–3 and >3 groups were independent prognostic factors (1–3: HR 2.856, p < 0.001; >3: HR 3.358, p < 0.001), so as the 0–50% and >50% positive lymph node ratio groups (0–50%: HR 2.124, p < 0.001; >50%: HR 3.358, p < 0.001). And in the groups of N2&positive lymph node number ≥4 and N2&positive lymph node ratio >50%, postoperative radiation related to positive prognosis of NSCLC patients. In conclusion, positive lymph node number or ratio was associated with survival as an independent indicator in NSCLC. They also had predictive effects for postoperative radiation, while N nodal stage not.

Highlights

Lung cancer remains as the most common malignancy with high mortality worldwide[1]
When we analyzed the prognostic effects of positive lymph node number and ratio in all included Non-small cell lung cancer (NSCLC) patients by K-M curves, we found they were both associated with overall survival (OS) (p < 0.001 for both) significantly (Fig. 2)
In 2006, Fukui T and his colleagues firstly proved that the number of positive lymph node had significance in resected NSCLC patients[12], and some studies were conducted confirming the result[11, 13]

Summary

Introduction

Lung cancer remains as the most common malignancy with high mortality worldwide[1]. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all cases[2], and the 5-year survival rate is still low despite great advance has been made in diagnosis and treatment. The prognostic effects of positive lymph number and ratio for NSCLC have been reported in some studies[7, 11,12,13], and here, we used the Surveillance, Epidemiology, and End Results (SEER) Database aiming to expand the sample volume and confirm their values in prognosis. Surgery is an effective way for NSCLC patients at early stage Among these operable patients, there are some harboring microscopic disease, and postoperative radiation might be performed aiming to reduce local recurrence and improve the outcome. Positive lymph node number and ratio might have prognostic effects like N nodal stage, so we used a larger sample volume from 1988 to 2013 to further identify whether they have predictive values for postoperative radiation. Characteristics All patients Age ≤65 >65 Gender Female Male Histological subtype Adenocarcinoma Squamous carcinoma Others Race White Black other unknown Tumor size T ≤ 3 cm 3 < T ≤ 5 cm 5 < T ≤ 7 cm T > 7 cm unknown N stage N0 N1 N2 Surgery type Pneumonectomy Lobectomy Local resection unknown

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Conclusion