Prognostic Impact of Number of Resected and Involved Lymph Nodes at Complete Resection on Survival in Non-small Cell Lung Cancer
Prognostic Impact of Number of Resected and Involved Lymph Nodes at Complete Resection on Survival in Non-small Cell Lung Cancer
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DOI：
10.1097/jto.0b013e31822a35c3
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发表时间：
2011-11-01
影响因子：
20.4
通讯作者：
Ikeda, Norihiko
中科院分区：
文献类型：
--
作者：
Saji, Hisashi;Tsuboi, Masahiro;Ikeda, Norihiko
背景：淋巴结（LN）状态是肺癌患者分期和生存的主要决定因素。在第7版的TNM恶性肿瘤分类中，乳腺癌、胃癌、食管癌和结直肠癌的pN因子定义中包括了累及淋巴结的数量，pN状态与预后显著相关。我们回顾性研究了切除淋巴结（RLN）和累及淋巴结的数量在其他已确定的临床预后因素的背景下对预后的影响，方法：收集2000年至2007年间在我院行完全切除术的928例非小细胞肺癌（NSCLC）患者的临床资料。在小于10和>= 10之间分类的RLN总数存在显著差异（p = 0.0129）。尽管LN受累的发生率与不良预后有统计学相关性，但在0 - 3个和≥ 4个受累LN之间观察到总生存率的最大统计学显著性增加（风险比= 7.680; 95%置信区间= 5.051-11.655，p < 0.0001）。在多变量分析中，我们使用了涉及LN和RLN的数量之间的比值。RLN的数目是NSCLC的一个强的独立预后因素（危险比= 6.803，95%可信区间= 4.137-11.186，p < 0.0001）。4个淋巴结受累似乎是NSCLC预后的基准。浸润淋巴结的数目是影响非小细胞肺癌预后的一个重要独立因素，本研究的结果可能为下一步的肿瘤、淋巴结、转移分类中确定N类别提供新的信息。
Background: Lymph node (LN) status is a major determinant of stage and survival in patients with lung cancer. In the 7th edition of the TNM Classification of Malignant Tumors, the number of involved LNs is included in the definition of pN factors in breast, stomach, esophageal, and colorectal cancer, and the pN status significantly correlates with prognosis.Methods: We retrospectively investigated the prognostic impact of the number of resected LNs (RLNs) and involved LNs in the context of other established clinical prognostic factors, in a series of 928 consecutive patients with non-small cell lung cancer (NSCLC) who underwent complete resection at our institution between 2000 and 2007.Results: The mean number of RLNs was 15. There was a significant difference in the total number of RLNs categorized between less than 10 and >= 10 (p = 0.0129). Although the incidence of LN involvement was statistically associated with poor prognosis, the largest statistically significant increase in overall survival was observed between 0 to 3 and >= 4 involved LNs (hazard ratio = 7.680; 95% confidence interval = 5.051-11.655, p < 0.0001). On multivariate analysis, we used the ratio between the number of involved LNs and RLNs. The number of RLNs was found to be a strong independent prognostic factor for NSCLC (hazard ratio = 6.803; 95% confidence interval = 4.137-11.186, p < 0.0001).Conclusion: Complete resection including 10 or more LNs influenced survival at complete NSCLC resection. Four involved LNs seemed to be a benchmark for NSCLC prognosis. The number of involved LNs is a strong independent prognostic factor in NSCLC, and the results of this study may provide new information for determining the N category in the next tumor, node, metastasis classification.