Lymph Node Ratio Predicts Recurrence and Survival After R0 Resection for Non-Small Cell Lung Cancer
Lymph Node Ratio Predicts Recurrence and Survival After R0 Resection for Non-Small Cell Lung Cancer
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DOI：
10.1016/j.athoracsur.2013.04.031
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发表时间：
2013-10-01
影响因子：
4.6
通讯作者：
Jones, David R.
中科院分区：
文献类型：
--
作者：
Taylor, Matthew D.;LaPar, Damien J.;Jones, David R.
背景目前的TNM非小细胞肺癌（NSCLC）分期仅使用淋巴结的解剖位置来定义N状态。其他几个癌症分期系统已经发现淋巴结比率（LNR）-阳性淋巴结的数量/切除的总淋巴结-是切除后生存的更好预测因子。本研究的目的是评估LNR作为非小细胞肺癌R 0切除术后复发和生存的预测因子。1999年至2008年间，在一家高容量的单一机构中，共有1,143例连续患者接受了NSCLC R 0切除术，其中26%（n = 302）患有N1和N2疾病。该研究的主要终点是长期生存率和复发率作为LNR的函数。采用考克斯比例风险模型和Kaplan-Meier生存分析评估LNR、N状态和病理分期与肺癌切除术后生存和复发的关系。中位随访时间为44个月，97%的患者完成了随访。本研究中患者的淋巴结状态如下：N 0疾病，73.5%; N1疾病，18.7%; N2疾病，7.8%。有淋巴结转移者132例（43.7%）复发。研究中患者的病理分期如下：IIA期，47%; IIB期，17%; IIIA期，35%; IIIB期，1%。平均淋巴结采样总数为11.1 +/- 6.0，平均阳性淋巴结数量为2.4 +/- 2.0。经统计学建模，发现LNR与NSCLC切除术后生存率下降独立相关（风险比2.63，置信区间：1.41至4.91，p = 0.002）。在接受NSCLC切除术的患者中，淋巴结比率增加与R 0切除术后生存率降低和复发时间缩短独立相关。(C)2013年由胸外科医师协会
Background. Current TNM non-small cell lung cancer (NSCLC) staging uses only the anatomic location of lymph nodes to define N status. Several other cancer staging systems have found lymph node ratio (LNR)-the number of positive lymph nodes/total lymph nodes resected-to be a better predictor of survival after resection. The purpose of this study is to evaluate LNR as a predictor of recurrence and survival after R0 resection for NSCLC.Methods. A total of 1,143 consecutive patients underwent R0 resection for NSCLC between 1999 and 2008 at a high-volume single institution with 26% (n = 302) having N1 and N2 disease. The primary endpoints of the study were long-term survival and recurrence as a function of LNR. Cox proportional hazard models and Kaplan-Meier survival analyses were utilized to assess associations between LNR, N status, and pathologic stage with survival and recurrence after lung cancer resection.Results. Median follow-up was 44 months and was complete in 97% of patients. Nodal status of patients in this study was as follows: N0 disease, 73.5%; N1 disease, 18.7%; and N2 disease, 7.8%. There were 132 recurrences in patients with nodal disease (43.7%). The pathologic stage of patients in the study was as follows: stage IIA, 47%; stage IIB, 17%; stage IIIA, 35%; and stage IIIB, 1%. Mean total number of lymph nodes sampled was 11.1 +/- 6.0 and mean number of positive lymph nodes 2.4 +/- 2.0. Upon statistical modeling, LNR was found to be independently associated with decreased survival after resection for NSCLC (hazard ratio 2.63, confidence interval: 1.41 to 4.91, p = 0.002).Conclusions. In patients undergoing resection for NSCLC, increasing lymph node ratio is independently associated with decreased survival and decreased time to recurrence after R0 resection. (C) 2013 by The Society of Thoracic Surgeons