Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non-Small-Cell Lung Cancer: A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry.
Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non-Small-Cell Lung Cancer: A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry.
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检查的淋巴结计数对切除的非小细胞肺癌的精确分期和长期生存的影响：美国 SEER 数据库和中国多机构登记的人群研究
DOI：
10.1200/jco.2016.67.5140
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发表时间：
2017-04-10
期刊：
影响因子：
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通讯作者：
He J
中科院分区：
文献类型：
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作者：
Liang W;He J;Shen Y;Shen J;He Q;Zhang J;Jiang G;Wang Q;Liu L;Gao S;Liu D;Wang Z;Zhu Z;Ng CS;Liu CC;Petersen RH;Rocco G;D'Amico T;Brunelli A;Chen H;Zhi X;Liu B;Yang Y;Chen W;Zhou Q;He J
我们通过使用大型数据库研究了非小细胞肺癌（NSCLC）检查淋巴结（ELN）数量与正确分期和长期生存之间的相关性，并确定了ELN计数的最低阈值。采用多变量模型分析了中国多机构注册和美国SEER数据库中2001 - 2008年I - IIIA期非小细胞肺癌切除术的数据，分析了ELN计数与分期迁移和总生存期（OS）之间的关系。平均正LNs、优势比（or）和风险比（hr）序列采用LOWESS平滑器拟合，结构断点采用Chow检验确定。选定的切入点在SEER 2009队列中得到验证。虽然ELN计数的分布在中国注册表（n = 5706）和SEER数据库（n = 38806，中位数分别为15和7）之间存在差异，但两个队列从N0疾病到N1和N2疾病（SEER OR, 1.038，中国OR， 1.012， P均< 0.001）和OS的连续改善（N0疾病：SEER HR， 0.986，中国HR， 0.981， P均< 0.001），N1和N2疾病：SEER HR， 0.989，中国HR， 0.984；P < 0.001)，在控制混杂因素后，ELN计数增加。切点分析显示，在宣布淋巴结阴性的患者中，阈值ELN计数为16，在衍生队列中进行了检查（SEER 2001 - 2008 HR, 0.830；中国HR， 0.738），并在SEER 2009队列中进行了验证（HR, 0.837）。更多的eln与更准确的淋巴结分期和切除的NSCLC更好的长期生存相关。我们推荐16个eln作为淋巴结阴性患者术后评估LN检查质量或预后分层的切入点。
We investigated the correlation between the number of examined lymph nodes (ELNs) and correct staging and long-term survival in non–small-cell lung cancer (NSCLC) by using large databases and determined the minimal threshold for the ELN count. Data from a Chinese multi-institutional registry and the US SEER database on stage I to IIIA resected NSCLC (2001 to 2008) were analyzed for the relationship between the ELN count and stage migration and overall survival (OS) by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. The selected cut point was validated with the SEER 2009 cohort. Although the distribution of ELN count differed between the Chinese registry (n = 5,706) and the SEER database (n = 38,806; median, 15 versus seven, respectively), both cohorts exhibited significantly proportional increases from N0 to N1 and N2 disease (SEER OR, 1.038; China OR, 1.012; both P < .001) and serial improvements in OS (N0 disease: SEER HR, 0.986; China HR, 0.981; both P < .001; N1 and N2 disease: SEER HR, 0.989; China HR, 0.984; both P < .001) as the ELN count increased after controlling for confounders. Cut point analysis showed a threshold ELN count of 16 in patients with declared node-negative disease, which were examined in the derivation cohorts (SEER 2001 to 2008 HR, 0.830; China HR, 0.738) and validated in the SEER 2009 cohort (HR, 0.837). A greater number of ELNs is associated with more-accurate node staging and better long-term survival of resected NSCLC. We recommend 16 ELNs as the cut point for evaluating the quality of LN examination or prognostic stratification postoperatively for patients with declared node-negative disease.