Abstract
BackgroundThe prognostic role of the number of resected lymph nodes (nLNs) in pathologic N0 (lymph node negative) and Nx (no lymph node examined) non-small cell lung cancer (NSCLC) patients remains uncertain. Guidelines for optimal nLNs have not been established. In the current study, we evaluated whether a higher number of resected lymph nodes (LNs) results in better survival in different tumor size categories among NSCLC patients without metastatic LNs.MethodA retrospective study was conducted. Based on nLNs (LN = 0, 1–7, >7) and tumor size (Ta: ≤3.5cm, Tb: >3.5cm) during surgery, patients were categorized into 6 groups (LN0Ta, LN0Tb, LN1–7Ta, LN1–7Tb, LN7-Ta and LN7-Tb). Survival and multivariate analyses were carried out to determine whether nLNs combined with tumor size was significant for overall survival (OS) or disease free survival (DFS) after adjusting for potential confounders.ResultsA total of 428 patients were enrolled in the study. Multivariate analysis demonstrated that nLNs, tumor size and pathological stage were the independent prognosticators for OS and DFS. Data from our study suggested that lung cancer lymphadenectomy with more than 7 LNs removed should be considered a benchmark for surgery or pathology at an early stage. Survival was significantly better in the LN7-Ta group, compared with other 5 groups (p<0.001).ConclusionsThe combined predictor (nLNs combined with tumor size) is an independent prognostic factor and a reasonable stratification criterion in patients with pathologic N0 and Nx NSCLC. The validation of our finding is warranted in further investigation.
Highlights
Lung cancer retains the status of leading cause of cancer-related deaths in both men and women in the United States, with 159,480 estimated deaths in 2013 [1]
Multivariate analysis demonstrated that number of resected lymph nodes (nLNs), tumor size and pathological stage were the independent prognosticators for overall survival (OS) and disease free survival (DFS)
The combined predictor is an independent prognostic factor and a reasonable stratification criterion in patients with pathologic N0 and Nx non-small cell lung cancer (NSCLC)
Summary
Lung cancer retains the status of leading cause of cancer-related deaths in both men and women in the United States, with 159,480 estimated deaths in 2013 [1]. The therapeutic effect of the extent of lymph node (LN) dissection and the optimal number of examined lymph nodes (nLNs) during surgery in patients with non-small cell lung cancer (NSCLC) remains controversial[3,4,5,6]. Patients who had no LNs examined, which termed ‘pathologic Nx’ (pNx), are often excluded to analyze the correlation between nLNs and outcomes. As these patients are often treated as pathologic N0 in clinical practice, they were comparative and have some commonalities on characteristics with pN0 patients. The prognostic role of the number of resected lymph nodes (nLNs) in pathologic N0 (lymph node negative) and Nx (no lymph node examined) non-small cell lung cancer (NSCLC) patients remains uncertain. We evaluated whether a higher number of resected lymph nodes (LNs) results in better survival in different tumor size categories among NSCLC patients without metastatic LNs
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