Number of lymph nodes and metastatic lymph node ratio are associated with survival in lung cancer.
Number of lymph nodes and metastatic lymph node ratio are associated with survival in lung cancer.
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DOI：
10.1016/j.athoracsur.2012.01.065
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发表时间：
2012-05
期刊：
影响因子：
--
通讯作者：
Reid M
中科院分区：
文献类型：
--
作者：
Nwogu CE;Groman A;Fahey D;Yendamuri S;Dexter E;Demmy TL;Miller A;Reid M
非小细胞肺癌（NSCLC） TNM分类系统仅使用淋巴结（LN）转移的解剖范围来定义N类。在其他实体肿瘤中，切除的LNs数量和阳性LNs与总检查LNs的比率是预后的指标。我们使用监测、流行病学和最终结果（SEER）数据库来调查这些参数对NSCLC总生存期的影响。在1988-2007年SEER数据库中，所有行根治性切除且至少检查过一个淋巴结的NSCLC患者均被纳入研究。年龄、种族、性别、肿瘤大小、组织学分级、检查的淋巴结数量和阳性淋巴结与总检查淋巴结的比率使用多变量Cox比例风险模型评估总生存率的预后价值。检查的节点数量分为四个级别。LN阳性百分比分为三个水平。在局限性疾病患者中，检查的淋巴结越少，预后越差。随着更多的LNs被检查，预后得到改善。对于区域性疾病患者，差异仅在极端情况下才显著。老年患者、男性和肿瘤级别较高或较大的患者的情况更糟。低或中等比例的患者比高比例的患者预后更好。切除的LNs越多，阳性LNs占总检查LNs的比例越低，与非小细胞肺癌切除术后患者的生存率越高相关，与年龄、性别、肿瘤分级、肿瘤大小和疾病分期无关。
The non-small cell lung cancer (NSCLC) TNM classification system uses only the anatomic extent of lymph node (LN) metastases to define the N category. The number of LNs resected and the ratio of positive LNs to total examined LNs are prognostic in other solid tumors. We used the Surveillance, Epidemiology and End Results (SEER) database to investigate the impact of these parameters on the overall survival of NSCLC. All patients with NSCLC in the SEER database from 1988–2007 who had curative resections and had at least one lymph node examined were included. The prognostic value of age, race, sex, tumor size, histologic grade, number of examined LNs and ratio of positive LNs to total examined nodes was assessed using a multivariate Cox proportional hazards model for overall survival. The number of nodes examined was categorized into four levels. The percent LN positive was stratified into three levels. Among patients with localized disease, fewer nodes examined corresponded with a worse prognosis. Prognosis improved as more LNs were examined. For patients with regional disease, the differences were significant only at the extremes. Older patients, males and those with higher grade or larger tumors did worse. Patients with low or moderate ratios of positive to total LNs had better prognoses than those with high ratios. More LNs resected and lower ratios of positive LNs to total examined LNs are associated with better patient survival after NSCLC resection independent of age, sex, grade, tumor size and stage of disease.
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