Value of N1 Lymph Node Examination in the Prognosis of Patients With pT1-3N0M0 Non-Small Cell Lung Cancer.

Gaoxiang Wang,Mingran Xie,Tian Li,Xianning Wu,Meiqing Xu,Xiaohui Sun,Liangdong Xu

doi:10.3389/fonc.2020.603378

Abstract

ObjectiveThis study aimed to analyze the relationship between the number of examined lymph nodes (ELNs) at the N1 station and the postoperative clinicopathological features and prognosis of patients with pT1-3N0M0 non-small cell lung cancer (NSCLC).MethodsThe cut-off value of the number of ELNs at the N1 station was obtained using X-tile software analysis. Kaplan-Meier survival curve analysis and the Cox proportional hazard model were used to study the impact of the number of ELNs at the N1 station on the prognosis of postoperative patients with pT1-3N0M0 NSCLC.ResultsThe median survival time and 1-, 3- and 5-year survival rates of 0 ELNs at the N1 station were 28.0 months and 74.8%, 45.4%, and 21.2%, respectively. The median survival time and 1-, 3-, and 5-year survival rates of 1–4 ELNs at the N1 station were 45.0 months and 85.5%, 55.4%, and 39.1%, respectively. In the group with ≥ 5 ELNs at the N1 station, the median survival time and the 1-, 3- and 5-year survival rates were 59.0 months and 94.0%, 62.7%, and 48.2%, respectively. Both univariate and multivariate Cox regression analyses showed that the number of ELNs at the N1 station, T stage and operation type were independent factors affecting the prognosis of patients with pT1-3N0M0 NSCLC.ConclusionIncreasing the number of ELNs at the N1 station is positively correlated with the long-term survival rate of patients with T1-3N0M0 NSCLC. At least 5 LNs at the N1 station should be examined in pathological examination.

Highlights

The morbidity and mortality of lung cancer are ranked first among all malignant tumors in the world [1, 2]
According to the relationship between the number of examined lymph nodes (ELNs) at the N1 station and overall survival (OS) in patients with pT1-3N0M0 non-small cell lung cancer (NSCLC), the cohort was divided into three groups based on the X-tile model: 0 ELNs at the N1 station, 1– 4 ELNs at the N1 station and ≥ 5 ELNs at the N1 station
0 ELNs at the N1 station were defined as Group A, 1–4 ELNs at the N1 station were defined as Group B, and ≥ 5 ELNs at the N1 station were defined as Group C

Summary

Introduction

The morbidity and mortality of lung cancer are ranked first among all malignant tumors in the world [1, 2]. NSCLC patients with positive lymph nodes have a high risk of recurrence after surgery. Lymph node involvement is an important factor that determines the prognosis and treatment decision of postoperative NSCLC patients. Lymph node resection or sampling plays a crucial role in accurate lymph node staging. The results of lymph node pathological examination can determine the postoperative lymph node stage of the patient, determine the postoperative pathological stage of the patient, and guide the step of treatment. Accurate postoperative staging is the key to determine whether patients should receive adjuvant therapy after surgery. According to the International Association for Lung Cancer Research’s lymph node map, the NCCN guidelines recommend that thoracic surgeons sample only one or more lymph nodes from mediastinal lymph node stations (2R, 4R, 7, 8 and 9 on the right; 4L, 5, 6, 7, 8 and 9 on the left) [5, 6]

Methods

Results

Discussion

Conclusion