Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer.
Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer.
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DOI：
10.1136/thx.2010.148601
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发表时间：
2011-04
期刊：
影响因子：
10
通讯作者：
Halm EA
中科院分区：
文献类型：
--
作者：
Wisnivesky JP;Arciniega J;Mhango G;Mandeli J;Halm EA
淋巴结转移是非小细胞肺癌(NSCLC)患者生存的重要预测指标。然而，N1疾病患者LN受累程度的预后意义尚不清楚。进行了一项研究，以评估与已知预后因素无关的较高数量的N1淋巴结是否与较差的生存相关。利用监测、流行病学和最终结果-医疗保险数据库，确认了1992至2005年间确诊的1682名确诊为N1非小细胞肺癌的切除患者。由于阳性淋巴结的数量与抽样的淋巴结总数相混淆，因此根据阳性与切除淋巴结总数的比率(LNR值)将病例分为三组：≤0.15、0.16~0.5和>；0.5。使用Kaplan-Meier曲线比较这些组之间的肺癌特异性和总体生存率。在调整潜在混杂因素后，采用分层和COX回归分析来评估LNR与生存的关系。肺癌特异性生存率和总体生存率在高下降率的患者中较低(P<；两个比较均为0.0001)。在≤0.15、0.16-0.5和>；0.5LNR组中，肺癌患者的中位生存期分别为47个月、37个月和21个月。在分层和调整的分析中，较高的LNR也与较差的肺癌特异性和总体生存率相关。LN受累的程度可为N1 NSCLC患者提供独立的预后信息。这一信息可用于识别复发风险较高的患者，这些患者可能受益于积极的术后治疗。
Lymph node (LN) metastasis is an important predictor of survival for patients with non-small cell lung cancer (NSCLC). However, the prognostic significance of the extent of LN involvement among patients with N1 disease remains unknown. A study was undertaken to evaluate whether involvement of a higher number of N1 LNs is associated with worse survival independent of known prognostic factors. Using the Surveillance, Epidemiology and End Results-Medicare database, 1682 resected patients with N1 NSCLC diagnosed between 1992 and 2005 were identified. As the number of positive LNs is confounded by the total number of LNs sampled, the cases were classified into three groups according to the ratio of positive to total number of LNs removed (LN ratio (LNR)): ≤0.15, 0.16–0.5 and >0.5. Lung cancer-specific and overall survival was compared between these groups using Kaplan–Meier curves. Stratified and Cox regression analyses were used to evaluate the relationship between the LNR and survival after adjusting for potential confounders. Lung cancer-specific and overall survival was lower among patients with a high LNR (p<0.0001 for both comparisons). Median lung cancer-specific survival was 47 months, 37 months and 21 months for patients in the ≤0.15, 0.16–0.5 and >0.5 LNR groups, respectively. In stratified and adjusted analyses, a higher LNR was also associated with worse lung cancer-specific and overall survival. The extent of LN involvement provides independent prognostic information in patients with N1 NSCLC. This information may be used to identify patients at high risk of recurrence who may benefit from aggressive postoperative therapy.
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