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Takamori S, Osoegawa A, Hashinokuchi A, Karashima T, Takumi Y, Abe M, Yamaguchi M, Takenaka T, Yoshizumi T, Zhu J, Komiya T. Role of Pathologic Single-N and Multiple-N Descriptors in Resected Non-Small Cell Lung Cancer. Chest 2024:S0012-3692(24)04605-1. [PMID: 39004218 DOI: 10.1016/j.chest.2024.06.3797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND The eighth edition of lung cancer N staging assignment includes the location of lymph node metastasis, but does not include single-N and multiple-N descriptors. RESEARCH QUESTION Do the single-N and multiple-N statuses stratify the prognosis of patients with non-small cell lung cancer (NSCLC)? STUDY DESIGN AND METHODS Using the National Cancer Database, we analyzed patients with pathologically staged N1 and N2 NSCLC. N descriptors were classified into pathological single N1 (pSingle-N1), pathological multiple N1 (pMulti-N1), pathological single N2 (pSingle-N2), and pathological multiple N2 (pMulti-N2). Survival analysis was performed using the Kaplan-Meier method and multivariable Cox regression models. RESULTS In the general analysis cohort, 24,531, 22,256, 8,528, and 21,949 patients with NSCLC demonstrated pSingle-N1, pMulti-N1, pSingle-N2, and pMulti-N2 disease, respectively. Patients with pMulti-N1 and pMulti-N2 disease showed a shorter survival than those with pSingle-N1 and pSingle-N2 disease, respectively (hazard ratio [HR], 1.22 [P < .0001] for N1 and 1.39 [P < .0001] for N2). After adjusting age, sex, and histologic findings, the HR for pSingle-N2 compared with pMulti-N1 disease was 1.05 (P = .0031). Patients with pN1 disease were categorized by metastatic lymph node count (1, 2, 3, ≥ 4), showing significant prognostic differences among groups (P < .0001). In the sensitivity analysis cohort (limited to R0 resection, lobectomy, or more; survival ≥ 30 days; ≥ 10 examined lymph nodes; and without neoadjuvant therapy; n = 34,904) and the external validation cohort (n = 708), analyses supported these results. INTERPRETATION Patients with NSCLC with one metastatic lymph node, whether in N1 or N2 stations, showed better survival than those with more than one lymph node involved. Patients with NSCLC with a single-skip N2 lymph node metastasis showed survival similar to patients with multiple N1 lymph nodes, and the number of lymph nodes involved in N1 resections up to four or more was sequentially prognostic.
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Affiliation(s)
- Shinkichi Takamori
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita
| | - Atsushi Osoegawa
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita
| | - Asato Hashinokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
| | - Takashi Karashima
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita
| | - Yohei Takumi
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita
| | - Miyuki Abe
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita
| | - Masafumi Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Takefumi Komiya
- Division of Hematology Oncology, Penn State College of Medicine, Hershey, PA.
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Strange CD, Strange TA, Erasmus LT, Patel S, Ahuja J, Shroff GS, Agrawal R, Truong MT. Imaging in Lung Cancer Staging. Clin Chest Med 2024; 45:295-305. [PMID: 38816089 DOI: 10.1016/j.ccm.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Lung cancer remains one of the leading causes of mortality worldwide, as well as in the United States. Clinical staging, primarily with imaging, is integral to stratify patients into groups that determine treatment options and predict survival. The eighth edition of the tumor, node, metastasis (TNM-8) staging system proposed in 2016 by the International Association for the Study of Lung Cancer remains the current standard for lung cancer staging. The system is used for all subtypes of lung cancer, including non-small cell lung cancer, small cell lung cancer, and bronchopulmonary carcinoid tumors.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA.
| | - Taylor A Strange
- Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Lauren T Erasmus
- Department of Anatomy and Cell Biology, Faculty of Sciences, McGill University, Montreal, QC H3A 0G4, Canada
| | - Smita Patel
- Department of Radiology, University of Michigan at Ann Arbor, 1500 E Medical Center Drive, SPC 5868, Ann Arbor, MI 48109, USA
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Rishi Agrawal
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
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Gao T, Chang Y, Yue H. Association of log odds of positive lymph nodes with survival in patients with small cell lung cancer: Results from the SEER database. Clinics (Sao Paulo) 2024; 79:100369. [PMID: 38696974 PMCID: PMC11070598 DOI: 10.1016/j.clinsp.2024.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/25/2024] [Accepted: 04/14/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES The prognosis of patients with Small Cell Lung Cancer (SCLC) can be predicted by their Lymph Node (LN) status. The authors aimed to assess the correlations between SCLC survival and number of LN Ratio (LNR), positive LN (pLNs), and Logarithmic Odds of positive LN (LODDS). METHODS This cohort study retrospectively included 1,762 patients with SCLC from the SEER database 2004‒2015. The X-tile software was used to determine the cutoff values for pLNs, LNR, and LODDS. The correlations between pLNs, LNR, and LODDS with Overall Survival (OS) and Cancer-Specific Survival (CSS) were explored using Cox regression analysis. The study used the C-index to assess the predictive value of LNR, pLNs, and LODDS on survival. RESULTS Among these 1,762 patients, 121 (6.87%) were alive, 1,641 (93.13%) died, and 1,532 (86.95%) died of SCLC. In univariable COX analysis, LNR, pLNs, and LODDS all showed a correlation with CSS and OS (p < 0.05). In multivariable COX analysis, only patients with LODDS (> 0.3 vs. ≤ 0.3) were related to both worse OS (HR = 1.28, 95% CI 1.10‒1.50) and CSS (HR = 1.29, 95% CI 1.10‒1.51), but no correction was observed between LNR and pLNs and survival (p > 0.05). The C-indices for predicting OS for LODDS were 0.552 (95% CI 0.541‒0.563), for LNR 0.504 (95% CI 0.501‒0.507), and for pLNs 0.527 (95% CI 0.514‒0.540). Moreover, the association between LODDS and prognosis in SCLC patients was significant only in patients with LN stage N1 and N2, but not in stage N3. CONCLUSION LODDS may be better than other LN assessment tools at predicting survival in SCLC patients.
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Affiliation(s)
- Ting Gao
- The First Clinical Medical College of Lanzhou University, Gansu, P.R. China; Department of Respiratory and Critical Care Medicine, Xianyang Central Hospital, Shaanxi, P.R. China
| | - Yingxuan Chang
- The First Clinical Medical College of Lanzhou University, Gansu, P.R. China
| | - Hongmei Yue
- The First Clinical Medical College of Lanzhou University, Gansu, P.R. China.
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Kim IH, Lee GD, Choi S, Kim HR, Kim YH, Kim DK, Park SI, Yun JK. Validation Study for the N Descriptor of the Newly Proposed Ninth Edition of the TNM Staging System Proposed by the International Association for the Study of Lung Cancer. J Thorac Oncol 2024:S1556-0864(24)00160-6. [PMID: 38614456 DOI: 10.1016/j.jtho.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/15/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION The aim of this study was to validate the discriminatory ability and clinical utility of the N descriptor of the newly proposed ninth edition of the TNM staging system for lung cancer in a large independent cohort. METHODS We retrospectively analyzed patients who underwent curative surgery for NSCLC between January 2004 and December 2019. The N descriptor of patients included in this study was retrospectively reclassified based on the ninth edition of the TNM classification. Survival analysis was performed using the log-rank test and Cox proportional hazard model to compare adjacent N categories. RESULTS A total of 6649 patients were included in this study. The median follow-up period was 54 months. According to the newly proposed ninth edition N classification, 5573 patients (83.8%), 639 patients (9.6%), 268 patients (4.0%), and 169 patients (2.5%) were classified into the clinical N0, N1, N2a, and N2b categories and 4957 patients (74.6%), 744 patients (11.2%), 567 patients (8.5%), and 381 patients (5.7%) were classified into the pathologic N0, N1, N2a, and N2b categories, respectively. The prognostic differences between all adjacent clinical and pathologic N categories were highly significant in terms of both overall survival and recurrence-free survival. CONCLUSIONS We validated the clinical utility of the newly proposed ninth edition N classification for both clinical and pathologic stages in NSCLC. The new N classification revealed clear prognostic separation between all categories (N0, N1, N2a, and N2b) in terms of both overall survival and recurrence-free survival.
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Affiliation(s)
- In Ha Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
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Ruiter J, de Langen A, Monkhorst K, Veenhof A, Klomp H, Smit J, Smit E, Damhuis R, Hartemink K. Survival difference between patients with single versus multiple metastatic lymph nodes and the role of histology in pathological stage II-N1 non-small cell lung cancer. Acta Chir Belg 2024:1-9. [PMID: 38404182 DOI: 10.1080/00015458.2024.2322243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Previous studies investigating whether metastatic lymph node count is a relevant prognostic factor in pathological N1 non-small cell lung cancer (NSCLC), showed conflicting results. Hypothesizing that outcome may also be related to histological features, we determined the prognostic impact of single versus multiple metastatic lymph nodes in different histological subtypes for patients with stage II-N1 NSCLC. METHODS We performed a retrospective cohort study using data from the Netherlands Cancer Registry, including patients treated with a surgical resection for stage II-N1 NSCLC (TNM 7th edition) in 2010-2016. Overall survival (OS) was assessed for patients with single (pN1a) and multiple (pN1b) metastatic nodes. Using multivariable analysis, we compared OS between pN1a and pN1b in different histological subtypes. RESULTS After complete resection of histologically proven stage II-N1 NSCLC, 1309 patients were analyzed, comprising 871 patients with pN1a and 438 with pN1b. The median number of pathologically examined nodes (N1 + N2) was 9 (interquartile range 6-13). Five-year OS was 53% for pN1a versus 51% for pN1b. In multivariable analysis, OS was significantly different between pN1a and pN1b (HR 1.19, 95% CI 1.01-1.40). When stratifying for histology, the prognostic impact of pN1a/b was only observed in adenocarcinoma patients (HR 1.44, 95% CI 1.15-1.81). CONCLUSION Among patients with stage II-N1 adenocarcinoma, the presence of multiple metastatic nodes had a significant impact on survival, which was not observed for other histological subtypes. If further refinement as to lymph node count will be considered for incorporation into a new staging system, evaluation of the role of histology is recommended.
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Affiliation(s)
- Julianne Ruiter
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Adrianus de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Kim Monkhorst
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Alexander Veenhof
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Houke Klomp
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jasper Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Egbert Smit
- Department of Pulmonary Diseases, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ronald Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Koen Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Xu L, Si H, Su H, Wang F, Wu J, She Y, Hu X, Xie D, Zhao D, Li Q, Guo J, Chen C. The number of metastatic lymph nodes is more predictive of prognosis than location-based N stage for nonsmall cell lung cancer: a retrospective cohort study. Int J Surg 2023; 109:4126-4134. [PMID: 37755369 PMCID: PMC10720786 DOI: 10.1097/js9.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The eighth edition of nodal classification is defined only by the anatomical location of metastatic lymph nodes and has limited prognostic discrimination power. The authors aimed to evaluate the prognostic significance and discriminatory capability of the number of metastatic lymph nodes (nN) in resected nonsmall cell lung cancer. MATERIALS AND METHODS Patients with stage IA to IIIB resected nonsmall cell lung cancer between 1 January 2009 and 31 December 2013 were analyzed as a Chinese cohort. The optimal thresholds for the nN classification were determined by the X-tile. The receiver operating characteristic curve, net reclassification improvement and standardized net benefit calculated by decision curve analysis was estimated to quantify the nN classification's performance in prognostic stratification. External validation in the surveillance, epidemiology, and end results database was performed to test the robustness of the nN classification. RESULTS Both cohorts showed a stepwise prognosis deterioration with increasing nN. One to three, four to six, and more than six were selected as optimal thresholds of nN classification in the Chinese cohort, which included 4432 patients, then validated in the SEER cohort ( n =28 022 patients). Multivariate Cox analysis showed the nN classification was an independent predictive factor for overall survival in both cohorts (Chinese cohort and SEER cohort: N 0 vs. N 1-3 , P <0.001; N 0 vs. N 3-6 , P <0.001; N 0 vs. N >6 , P <0.001). And prognostic discriminatory capability was improved in the nN classification compared with location-based N classification [5-year NRI score, 0.106 (95% CI: 0.049-0.132) and 5-year time-independent AUC, 0.593 (95% CI: 0.560-0.625) vs. 0.554 (95% CI: 0.520-0.588), P <0.001]. CONCLUSIONS The nN classification tended to be a superior prognostic indicator than the location-based N classification. The number of metastatic lymph nodes should be considered in the future revision of the TNM system.
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Affiliation(s)
- Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Haojie Si
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Fang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
| | - Jianbo Guo
- Department of Thoracic Surgery, The First People’s Hospital of Linhai, Taizhou, Zhejiang, People’s Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai
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Guo J, Zhang L, Zhang L, Wu J, Xu L, E H, Li C, Wu H, Zhao D, Hu Y, Zhang J, Hu X. The additional radiotherapy to adjuvant chemotherapy improves the prognosis of stage III-N2 with highest mediastinal lymph node metastasis in non-small cell lung cancer. J Cancer Res Clin Oncol 2023; 149:13311-13321. [PMID: 37488397 DOI: 10.1007/s00432-023-05101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The benefits of adjuvant chemoradiation therapy (CRT) for heterogeneous pathological N2 (pN2) diseases remain unclear in non-small cell lung cancer (NSCLC). This study aimed to investigate suitable pN2 patients for adjuvant CRT. MATERIAL AND METHODS This study retrospectively reviewed the data of patients with pN2 NSCLC in Shanghai Pulmonary Hospital from January 2012 to December 2016. Included cases were subdivided as highest mediastinal lymph node (HM) (n = 732) metastasis and non-HM metastasis (n = 677) groups according to the International Association for the Study of Lung Cancer (IASLC). Furthermore, the Kaplan-Meier and Cox models were used to evaluate the prognostic benefits of adjuvant CRT in heterogeneous pN2 subgroups. RESULTS A total of 1409 patients were enrolled in this study, with a median follow-up time of 63.8 months. Patients with HM involvement had worse prognoses (p < 0.001 for recurrence-free survival (RFS) and overall survival (OS)). Furthermore, the survival improvement of adjuvant CRT was significant for these patients (p < 0.001 for RFS and p = 0.032 for OS), regardless of whether it was single (p < 0.001 for RFS and p = 0.029 for OS) or multiple pN2 (p < 0.001 for RFS and p = 0.026 for OS) diseases. According to multivariable cox analysis, the long-term RFS and OS in the cancerous HM group were independently predicted by pathological N stage (p = 0.002 for RFS and p < 0.001 for OS) and adjuvant CRT (p < 0.001 for RFS and p = 0.011 for OS). CONCLUSION Metastatic HM was associated with a worse prognosis in pN2 disease. Our analysis supported that adjuvant CRT significantly improved both RFS and OS for these patients.
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Affiliation(s)
- Jianbo Guo
- Department of Thoracic Surgery, The First People's Hospital of Linhai, Zhejiang, 317000, People's Republic of China
| | - Lei Zhang
- Department of Thoracic Surgery, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Liping Zhang
- Department of Pathology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, People's Republic of China
| | - Junqi Wu
- Department of Thoracic Surgery, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Long Xu
- Department of Thoracic Surgery, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Haoran E
- Department of Thoracic Surgery, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Chongwu Li
- Department of Thoracic Surgery, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Hongyu Wu
- Department of Radiology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, People's Republic of China
| | - Deping Zhao
- Department of Thoracic Surgery, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, People's Republic of China
| | - Yumin Hu
- Department of Respiratory, The First People's Hospital of Linhai, Zhejiang, 317000, People's Republic of China.
| | - Jie Zhang
- Department of Medical Oncology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, People's Republic of China.
- Department of Oncology, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, People's Republic of China.
| | - Xuefei Hu
- Department of Thoracic Surgery, The First People's Hospital of Linhai, Zhejiang, 317000, People's Republic of China.
- Department of Thoracic Surgery, School of Medicine, Shanghai Pulmonary Hospital, Tongji University, No. 507 Zhengmin Road, Shanghai, 200433, People's Republic of China.
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Jang S, Lee S, Chung JH, Lee KW, Lee KH. Radiologic Extranodal Extension of Metastatic Lymph Nodes in Patients With Non-Small Cell Lung Cancer: Prognostic Utility and Diagnostic Performance. AJR Am J Roentgenol 2023; 221:471-484. [PMID: 37255045 DOI: 10.2214/ajr.23.29285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND. Pathologic extranodal extension (ENE) in metastatic lymph nodes (LNs) has been associated with unfavorable prognosis in patients with non-small cell lung cancer (NSCLC). OBJECTIVE. The purpose of this article was to evaluate the prognostic utility of radiologic ENE and its diagnostic performance in predicting pathologic ENE in patients with NSCLC. METHODS. This retrospective study included 382 patients (mean age, 67 ± 10 [SD] years; 297 men, 85 women) diagnosed with NSCLC and clinical N1 or N2 disease between January 2010 and December 2016. Two thoracic radiologists reviewed staging chest CT examinations to record subjective overall impression for radiologic ENE (no ENE, possible/probable ENE, or unambiguous ENE), reviewing 30 examinations in consensus and the remaining examinations independently. Kaplan-Meier survival analysis and multivariable Cox proportional hazards model were used to evaluate the utility of radiologic ENE in predicting overall survival (OS). Prognostic utility of radiologic ENE was also assessed in patients with clinical N2a disease. In patients who underwent surgery, sensitivity and specificity were determined of radiologic unambiguous ENE in predicting pathologic ENE. RESULTS. The 5-year OS rates for no ENE, possible/probable ENE, and unambiguous ENE were 44.4%, 39.1%, and 20.9% for reader 1 and 45.7%, 36.6%, and 25.6% for reader 2, respectively. Unambiguous ENE was an independent prognostic factor for worse OS (reader 1: adjusted HR, 1.72, p = .008; reader 2: adjusted HR, 1.56, p = .03), whereas possible/probable ENE was not (reader 1: adjusted HR, 1.18, p = .33; reader 2: adjusted HR, 1.21, p = .25). In patients with clinical N2a disease, 5-year OS rate in patients with versus without unambiguous ENE for reader 1 was 22.2% versus 40.6% (p = .59) and for reader 2 was 27.6% versus 41.0% (p = .49). In 203 patients who underwent surgery (66 with pathologic ENE), sensitivity and specificity of radiologic unambiguous ENE for predicting pathologic ENE were 11% and 93% for reader 1 and 23% and 87% for reader 2. CONCLUSION. Radiologic unambiguous ENE was an independent predictor of worse OS in patients with NSCLC. The finding had low sensitivity but high specificity for pathologic ENE. CLINICAL IMPACT. Radiologic ENE may have a role in NSCLC staging workup and treatment selection.
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Affiliation(s)
- Sowon Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seungjae Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
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Cai JS, Yang F, Wang X. Occult lymph node metastasis is not a favorable factor for resected NSCLC patients. BMC Cancer 2023; 23:822. [PMID: 37667180 PMCID: PMC10476354 DOI: 10.1186/s12885-023-11189-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/18/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND This study was to compare the clinical presentations and survivals between the non-small cell lung cancer (NSCLC) patients with occult lymph node metastasis (OLNM) and those with evident lymph node metastasis (ELNM). We also intended to analyze the predictive factors for OLNM. METHODS Kaplan-Meier method with log-rank test was used to compare survivals between groups. Propensity score matching (PSM) was used to reduce bias. The least absolute shrinkage and selection operator (LASSO)-penalized Cox multivariable analysis was used to identify the prognostic factors. Random forest was used to determine the predictive factors for OLNM. RESULTS A total of 2,067 eligible cases (N0: 1,497 cases; occult N1: 165 cases; evident N1: 54 cases; occult N2: 243 cases; evident N2: 108 cases) were included. The rate of OLNM was 21.4%. Patients with OLNM were tend to be female, non-smoker, adenocarcinoma and had smaller-sized tumors when compared with the patients with ELNM. Survival curves showed that the survivals of the patients with OLNM were similar to those of the patients with ELNM both before and after PSM. Multivariable Cox analysis suggested that positive lymph nodes (PLN) was the only prognostic factor for the patients with OLNM. Random forest showed that clinical tumor size was an important predictive factor for OLNM. CONCLUSIONS OLNM was not rare. OLNM was not a favorable sign for resected NSCLC patients with lymph node metastasis. PLN determined the survivals of the patients with OLNM. Clinical tumor size was a strong predictive factor for OLNM.
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Affiliation(s)
- Jing-Sheng Cai
- Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China
- Thoracic Oncology Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China.
- Thoracic Oncology Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China.
| | - Xun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China.
- Thoracic Oncology Institute, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China.
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10
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Hui WK, Charaf Z, Hendriks JMH, Van Schil PE. True Prevalence of Unforeseen N2 Disease in NSCLC: A Systematic Review + Meta-Analysis. Cancers (Basel) 2023; 15:3475. [PMID: 37444585 DOI: 10.3390/cancers15133475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67-9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31-58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored.
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Affiliation(s)
- Wing Kea Hui
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Zohra Charaf
- Department of Cardiothoracic Surgery, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
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11
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Shimizu Y, Koike T, Hasebe T, Nakamura M, Goto T, Toyabe SI, Tsuchida M. Surgical Treatment Outcomes of Patients with Non-Small Cell Lung Cancer and Lymph Node Metastases. Cancers (Basel) 2023; 15:3098. [PMID: 37370708 DOI: 10.3390/cancers15123098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to investigate the appropriate subgroups for surgery and adjuvant chemotherapy in patients with non-small-cell lung cancer (NSCLC) and nodal metastases. We retrospectively reviewed 210 patients with NSCLC and nodal metastases who underwent surgery and examined the risk factors for poor overall survival (OS) and recurrence-free probability (RFP) using multivariate Cox proportional hazards analysis. Pathological N1 and N2 were observed in 114 (52.4%) and 96 (47.6%) patients, respectively. A single positive node was identified in 102 patients (48.6%), and multiple nodes were identified in 108 (51.4%). Multivariate analysis revealed that vital capacity < 80% (hazard ratio [HR]: 2.678, 95% confidence interval [CI]: 1.483-4.837), radiological usual interstitial pneumonia pattern (HR: 2.321, 95% CI: 1.506-3.576), tumor size > 4.0 cm (HR: 1.534, 95% CI: 1.035-2.133), and multiple-node metastases (HR: 2.283, 95% CI: 1.517-3.955) were significant independent risk factors for poor OS. Tumor size > 4.0 cm (HR: 1.780, 95% CI: 1.237-2.562), lymphatic permeation (HR: 1.525, 95% CI: 1.053-2.207), and multiple lymph node metastases (HR: 2.858, 95% CI: 1.933-4.226) were significant independent risk factors for recurrence. In patients with squamous cell carcinoma (n = 93), there were no significant differences in OS or RFP between those who received platinum-based adjuvant chemotherapy (n = 25) and those who did not (n = 68), at p = 0.690 and p = 0.292, respectively. Multiple-node metastases were independent predictors of poor OS and recurrence. Patients with NSCLC and single-node metastases should be considered for surgery despite N2 disease. Additional treatment with platinum-based adjuvant chemotherapy may be expected, especially in patients with squamous cell carcinoma.
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Affiliation(s)
- Yuki Shimizu
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Toshiki Hasebe
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Masaya Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Tatsuya Goto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University, Niigata 951-8510, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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Benej M, Klikovits T, Krajc T, Bohanes T, Schulte L, Hochmair MJ, Watzka S, Mosleh B, Hoetzenecker K, Aigner C, Hoda MA, Mueller MR. Lymph Node Log-Odds Ratio Accurately Defines Prognosis in Resectable Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15072082. [PMID: 37046743 PMCID: PMC10093675 DOI: 10.3390/cancers15072082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives: The ratio of positive and resected lymph nodes (LN ratio) has been shown to be prognostic in non-small cell lung cancer (NSCLC). Contrary to the LN ratio, calculating the LN log-odds ratio (LN-LOR) additionally considers the total number of resected lymph nodes. We aim to evaluate LN-LOR between positive and resected lymph nodes as a prognostic factor in operable NSCLC. Methods: Patients with NSCLC who underwent curative intent lobectomy treated at two high-volume centers were retrospectively studied. LN-LOR was dichotomized according to impact on OS and further combined with N descriptors and correlated with clinical variables and survival. Results: 944 patients were included. Cut-off analysis revealed that an LN-LOR of −0.34 significantly discriminated patients according to OS (p < 0.001, chi-squared test 41.26). When combined with N1 and N2 descriptors, LN-LOR low risk (median OS not reached and 83 months) and LN-LOR high-risk patients (median OS 50 and 59 months) had similar survival irrespective of the anatomical location of the positive lymph nodes. Multivariable Cox regression analysis revealed that age (HR 1.02, 95% CI 1.001–1.032), sex (male, HR 1.65, 95% CI 1.25–2.19), histological subtype (HR 2.11, 95% CI 1.35–3.29), pathological stage (HR 1.23, 95% CI 1.01–1.45) and LN-LOR risk groups (low risk, HR 0.48, 95% CI 0.32–0.72) were independent prognostic factors for OS. Conclusions: This retrospective two-center analysis shows that LN-LOR is significantly associated with OS in resectable NSCLC and might better reflect the biological behavior of the disease, regardless of anatomical lymph node locations. This finding may additionally support the value of extensive LN dissection.
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Affiliation(s)
- Michal Benej
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Thomas Klikovits
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Tibor Krajc
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Tomas Bohanes
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Lisa Schulte
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Stefan Watzka
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Berta Mosleh
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Clemens Aigner
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Rolf Mueller
- Department of Thoracic Surgery and Karl-Landsteiner-Institute, Clinic Floridsdorf, 1210 Vienna, Austria
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13
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Sezen CB, Kalafat CE, Doğru MV, Aker C, Erdogu V, Saydam O, Metin M. The effect of lymph node ratio on survival in non-small-cell lung cancer. Acta Chir Belg 2023; 123:36-42. [PMID: 34006183 DOI: 10.1080/00015458.2021.1932181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of prognostic factors and lymph node ratio (LNR) on survival in patients with resected non-small-cell lung cancer (NSCLC). METHODS Data from 421 patients with NSCLC who underwent complete resection between 2009 and 2015 were evaluated retrospectively. LNR was defined as the ratio of positive lymph nodes to the total number of lymph nodes removed. Associations between overall survival (OS) and LNR, node (N) status, and histopathologic status were evaluated. RESULTS The 5-year survival rate was 42.5% among all patients and 26.6% for patients aged 65 years or older. In the multivariate analysis, age ≥65 years, advanced-stage disease, non-squamous cell carcinomas, pN status, and having multiple-station pN2 and multiple-station pN1 disease were found to be poor prognostic factors (p < 0.05). There was no statistical difference in survival between patients with LNR (hazard ratio: 1.04, p = 0.45). CONCLUSION The results of our study indicate that pN stage, histopathologic type, pT stage, and geriatric age were the most important poor prognostic factors associated with survival after NSCLC resection. Although LNR is a factor associated with survival in gastrointestinal cancers, it did not impact survival in our study.
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Affiliation(s)
- Celal Bugra Sezen
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Cem Emrah Kalafat
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Vedat Doğru
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Volkan Erdogu
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ozkan Saydam
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
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Archer JM, Truong MT, Shroff GS, Godoy MCB, Marom EM. Imaging of Lung Cancer Staging. Semin Respir Crit Care Med 2022; 43:862-873. [PMID: 35815631 DOI: 10.1055/s-0042-1753476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lung cancer is a leading cause of cancer-related mortality worldwide. Imaging is integral in accurate clinical staging to stratify patients into groups to predict survival and determine treatment. The eighth edition of the tumor, node, and metastasis (TNM-8) staging system proposed by the International Association for the Study of Lung Cancer in 2016, accepted by both the Union for International Cancer Control and the American Joint Committee on Cancer, is the current standard method of staging lung cancer. This single TNM staging is used for all histologic subtypes of lung cancer, including nonsmall cell lung cancer, small cell lung cancer, and bronchopulmonary carcinoid tumor, and it addresses both clinical and pathologic staging. Familiarity with the strengths and limitations of imaging modalities used in staging, the nuances of TNM-8, its correct nomenclature, and potential pitfalls are important to optimize patient care. In this article, we discuss the role of computed tomography (CT) and positron emission tomography/CT in lung cancer staging, as well as current imaging recommendations pertaining to TNM-8.
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Affiliation(s)
- J Matthew Archer
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas Monroe Dunaway Anderson Cancer Center, Houston, Texas
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas Monroe Dunaway Anderson Cancer Center, Houston, Texas
| | - Myrna C B Godoy
- Department of Thoracic Imaging, University of Texas Monroe Dunaway Anderson Cancer Center, Houston, Texas
| | - Edith M Marom
- Department of Diagnostic Radiology, Tel Aviv University, Chaim Sheba Medical Center, Ramat Gan, Israel
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15
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Zhang Y, Liu Z, Wang H, Liang F, Zhu L, Liu H. Association of metastatic nodal size with survival in non-surgical non-small cell lung cancer patients: Recommendations for clinical N staging. Front Oncol 2022; 12:990540. [PMID: 36338722 PMCID: PMC9633939 DOI: 10.3389/fonc.2022.990540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
Background This study aims to analyze the prognostic significance of the metastatic lymph node (mLN) size in non-small cell lung cancer (NSCLC) patients receiving chemoradiotherapy (CRT) to provide some information for the optimization of clinical nodal (cN) staging. Methods A retrospective study with 325 NSCLC patients was conducted between January 2011 and December 2018 at two participating institutes. We evaluated the potential relationship between the mLN size and the survival to propose a potential revised nodal (rN) staging. Results Kaplan–Meier analyses showed significant differences in the overall survival (OS) based on the cN staging and the size of mLNs (N0, ≤2 cm, and >2 cm). We found that the nodal size correlated statistically with the response to CRT. The HRs of OS for patients with bulky mLNs increase significantly compared with patients in the non-bulky mLNs group in the cN2-3 group. Interestingly, the HRs of patients with bulky cN2 disease and non-bulky cN3 disease were similar to each other. We classified the patients into five subsets: N0, rN1(cN1), rN2(non-bulky cN2), rN3a(bulky cN2, and non-bulky cN3), and rN3b(bulky cN3). In our study, the rN stage showed better prognostic discrimination than the 8th IASLC cN staging and was an independent prognostic factor for survival. Conclusions In addition to the anatomic location, the size of mLNs correlated statistically with the response to CRT and should be incorporated into the cN staging system to predict survival more accurately.
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Affiliation(s)
- Yanan Zhang
- Department of Geriatrics, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
| | - Zhehui Liu
- Department of Geriatrics, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
| | - Hongmin Wang
- Joint Laboratory for Translational Medicine Research, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
| | - Fengfan Liang
- Department of Radiation Oncology, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
| | - Liqiong Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong First Medical University, Jinan, Shandong, China
| | - Haifeng Liu
- Department of Geriatrics, Liaocheng People’s Hospital, Shandong First Medical University, Liaocheng, Shandong, China
- *Correspondence: Haifeng Liu,
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16
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Wang Z, Yang Z, Li S, Zhang J, Xia L, Zhou J, Chen N, Guo C, Liu L. A Comprehensive Comparison of Different Nodal Subclassification Methods in Surgically Resected Non-Small-Cell Lung Cancer Patients. Ann Surg Oncol 2022; 29:8144-8153. [PMID: 35980551 DOI: 10.1245/s10434-022-12363-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The revision of the N descriptor in non-small-cell lung cancer has been widely discussed in the past few years. Many different subclassification methods based on number or location of lymph nodes have been proposed for better distinguishing different N patients. This study aimed to systematically collect them and provide a comprehensive comparison among different subclassification methods in a large cohort. METHOD Pathological N1 or N2 non-small-cell lung cancer patients undergoing surgical resection between 2005 and 2016 in the Western China Lung Cancer Database were retrospectively reviewed. A literature review was conducted to collect previous subclassification methods. Kaplan-Meier and multivariable Cox analyses were used to examine the prognostic performance of subclassification methods. Decision curve analysis, Akaike's information criterion, and area under the receiver operating curve concordance were also performed to evaluate the standardized net benefit of the subclassification methods. RESULTS A total of 1625 patients were identified in our cohort. Eight subclassification methods were collected from previous articles and further grouped into subclassification based on number categories (node number or station number), location categories (lymph node zone or chain) or combination of number and location categories. Subclassification based on combination of lymph node location and number tended to have better discrimination ability in multivariable Cox analysis. No significant superiority among the different subclassification methods was observed in the three statistical models. CONCLUSION Subclassification based on the combination of location and number could be used to provide a more accurate prognostic stratification in surgically resected NSCLC and is worth further validation.
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Affiliation(s)
- Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenyu Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Sijia Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Junqi Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Liang Xia
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Feng N, Wu B, Zhang X, Chen J, Xiang Z, Wei Y, Zhang W. Lymph node ratio predicts overall survival in patients with stage II non-small cell lung cancer: a population-based SEER analysis. Discov Oncol 2022; 13:75. [PMID: 35982330 PMCID: PMC9388711 DOI: 10.1007/s12672-022-00542-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/15/2022] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND In non-small-cell lung cancer (NSCLC), there are many factors that affect prognosis, and the lymph node ratio (LNR) may play a significant role. Our study aimed to confirm the value of the LNR in the prognosis of patients with stage II NSCLC. METHODS Patient data were obtained from the Surveillance, Epidemiology and End Results (SEER) database. The classification for the LNR was best determined using the X-tile method. The correlation between the LNR and overall survival (OS) was validated after the Kaplan-Meier analysis was performed. To determine the correlation between the LNR and survival, stratification and the Cox regression analysis were used. RESULTS In our study, 14,183 stage II NSCLC patients were included. Among them, 8303 patients had N1 disease. According to the X-tile analysis, the optimal critical points for the LNR in N1 patients with NSCLC was 0.21 and 0.38. We categorized the cohorts as low (LNR-L ≤ 0.21; n = 5158, 62.1%), medium (0.21 < LNR-M ≤ 0.38; n = 1736, 20.9%), and high (LNR-H > 0.38; n = 1409, 17.0%). According to the Kaplan-Meier analysis, the patients with a high LNR were considerably worse than those with a medium or low LNR (P < 0.001), which was also proven by stratified and multivariate analyses. The value of the LNR was reflected in all the subgroup analyses, especially in patients ages < 60 years. The multivariate competing risks regression analysis revealed that younger age, female sex, T1 disease, adenocarcinoma and N0 disease was associated with a better prognosis after controlling for potential confounders (P < 0.001). CONCLUSIONS For patients with stage II NSCLC, the LNR is valuable for assessing prognosis. A higher LNR indicates a worse prognosis.
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Affiliation(s)
- Nan Feng
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
| | - Bo Wu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
| | - Xiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
| | - Jianhui Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
| | - Zhongtian Xiang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, China.
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Poncelet AJ, Lacroix V. Lung cancer: is it node number or node station? Pardon me, but what is the question? Eur J Cardiothorac Surg 2022; 62:ezac397. [PMID: 35946536 DOI: 10.1093/ejcts/ezac397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 06/15/2023] Open
Affiliation(s)
- Alain Jean Poncelet
- Cardiovascular and Thoracic Surgery Department, Université Catholique de Louvain-Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Valérie Lacroix
- Cardiovascular and Thoracic Surgery Department, Université Catholique de Louvain-Cliniques Universitaires Saint-Luc, Brussels, Belgium
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The impacts of isolated N1 lymph nodes metastasis on prognosis in non-small cell lung cancer: A single-center experience. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:206-215. [PMID: 36168575 PMCID: PMC9473585 DOI: 10.5606/tgkdc.dergisi.2022.21303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/27/2021] [Indexed: 11/21/2022]
Abstract
Background: This study aims to investigate long-term results related to N1 group metastases with respect to anatomical localization and many external parameters and to examine the effect of these parameters on prognosis in patients with in nonsmall cell lung cancer.
Methods: Between January 2006 and May 2019, a total of 52 patients (44 males, 8 females; mean age: 59.9±9.5 years; range, 42 to 80 years) who underwent lobectomy due to primary lung malignancy were retrospectively analyzed. The N1 lymph nodes were divided into three anatomical groups as hilar, peribronchial, and intraparenchymal. Demographic features, tumor features, follow-up characteristics, and survival and diseasefree survival parameters were analyzed for each group. The results were also examined in terms of number of metastasis, number of metastatic levels, rate of metastasis, and histopathological type.
Results: The five-year survival rate was 66.4% in the peribronchial group and 50% in the hilar group. The five-year disease-free survival rate was 45.7% in the peribronchial group and 37.5% in the hilar group. There was no statistically significant difference between the groups in terms of survival and disease-free survival for anatomical localization, number of metastasis, number of metastatic levels, rate of metastasis, and histopathological type (p>0.05 for all).
Conclusion: The structure that would be formed by examining N1 in terms of parameters such as subtitle levels, number of metastasis, number of metastatic stations, rate of metastasis or combinations of these would have a more impact on the decisions in the follow-up and treatment process in this patient population.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6527003. [DOI: 10.1093/ejcts/ezac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 01/13/2022] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
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Hwangbo B, Park EY, Yang B, Lee GK, Kim TS, Kim HY, Kim MS, Lee JM. Long-Term Survival According to N Stage Diagnosed by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Non-Small Cell Lung Cancer. Chest 2021; 161:1382-1392. [PMID: 34896095 DOI: 10.1016/j.chest.2021.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the main procedure for mediastinal staging. However, long-term survival analyses according to cN stage diagnosed by EBUS-TBNA (abbreviated to eN stage) have not been reported. The value of EBUS-TBNA has not been assessed through an analysis of survival in false-negative EBUS-TBNA cases. RESEARCH QUESTIONS What is the prognostic impact of eN stage in non-small cell lung cancer (NSCLC)? What is the survival rate in false-negative EBUS-TBNA cases? STUDY DESIGN AND METHODS We retrospectively (January 2006-December 2011) reviewed the medical records of NSCLC patients who underwent EBUS-TBNA (± transesophageal approach) for initial staging (n=1,089). Mediastinoscopy was not performed for EBUS-TBNA negative cases. We performed 5-year survival analyses according to eN stage and treatment modality. Survival in false-negative EBUS cases was compared with that in pN0-1 patients, including 941 non-EBUS cases, during the same period. RESULTS Among 1,089 EBUS patients (eN0-1=681, eN2=314, eN3=94), we observed significant differences in survival between the eN stages [eN0-1 vs eN2; p <0.0001, eN2 vs eN3; p=0.0118, estimated 5-year overall survival (5YOS) rate: eN0-1=57.4%, eN2=23.2%, eN3=12.8%]. Surgery cases had better survival than non-surgery cases among eN0-1 and eN2 patients (eN0-1/surgery vs. eN0-1/no surgery; p<0.0001, eN2/surgery vs. eN2/no surgery; p<0.0001). Among eN0-1 patients, there were 55 false-negative cases (eN0-1/pN2-3, pN2=54, pN3=1). The 5YOS rates of pN0, pN1, and eN0-1/pN2-3 patients were 76.4%, 56.0% and 56.4%, respectively. eN0-1/pN2-3 patients had worse survival than pN0 patients (p=0.0061), whereas there was no significant difference compared with pN1 patients (p=0.9191). INTERPRETATIONS Long-term survival significantly differed according to eN stage in NSCLC, highlighting the importance of EBUS-TBNA in NSCLC staging. False-negative EBUS-TBNA cases had favorable survival which was similar to that of pN1 patients, which may provide a rationale for performing surgery after negative EBUS-TBNA results.
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Affiliation(s)
- Bin Hwangbo
- Division of Pulmonology, Center for Lung Cancer, National Cancer Center, Goyang, Korea.
| | - Eun Young Park
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, Korea
| | - Bumhee Yang
- Division of Pulmonology, Center for Lung Cancer, National Cancer Center, Goyang, Korea; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Geon Kook Lee
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Tae Sung Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang, Korea
| | - Hyae Young Kim
- Department of Radiology, Center for Lung Cancer, National Cancer Center, Goyang, Korea
| | - Moon Soo Kim
- Department of Thoracic Surgery, Center for Lung Cancer, National Cancer Center, Goyang, Korea
| | - Jong Mog Lee
- Department of Thoracic Surgery, Center for Lung Cancer, National Cancer Center, Goyang, Korea
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22
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Li Q, Chen Q, Chen J, Wang Z, Wang P, Zhao H, Zhao J. Prognostic nomogram for predicting long-term survival in bronchopulmonary carcinoid tumor patients receiving resection. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1402. [PMID: 34733954 PMCID: PMC8506713 DOI: 10.21037/atm-21-1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/01/2021] [Indexed: 11/06/2022]
Abstract
Background We analyzed bronchopulmonary carcinoid tumor (BPC) patients receiving resection from the Surveillance, Epidemiology, and End Results (SEER) database to identify the predictive factors of their survival. Then, we developed and validated nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in BPC patients. Methods BPC patients registered in the SEER database were included. They were divided into a training set and an internal validation set (7:3). BPC patients from our center were included as an external validation set. Independent prognostic factors identified by a Cox regression model in the training set were used to construct nomograms to predict survival. Discrimination and calibration plots were used to evaluate the predictive accuracy of the nomograms. The nomograms were evaluated in both the internal and the external validation datasets. Results Age, pathological type, and N stage were identified as independent prognostic factors of OS and CSS by Cox analyses (all P<0.05). Tumor size ≥2.5 cm (P=0.045) was an independent factor for unfavorable CSS. Based on these variables, nomograms were constructed. All concordance indexes of the training set, internal validation set, and external validation set indicated that the nomograms had the preferable discriminatory ability. The calibration plots for predictions of the 1-, 3-, and 5-year OS and CSS were in excellent agreement. Conclusions Age, pathological type, N stage, and tumor size were independent predictive factors of prognosis in BPC patients receiving resection. These nomograms could serve as effective and accurate tools for the prognostic evaluation of patients with BPCs.
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Affiliation(s)
- Qiao Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qichen Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinghua Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zijing Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pan Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Samejima J, Ito H, Nagashima T, Nemoto D, Eriguchi D, Nakayama H, Ikeda N, Okada M. Anatomical location and number of metastatic lymph nodes for prognosis of non-small cell lung cancer. J Thorac Dis 2021; 13:4083-4093. [PMID: 34422338 PMCID: PMC8339744 DOI: 10.21037/jtd-21-390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/27/2021] [Indexed: 12/25/2022]
Abstract
Background The nodal classification of lung cancer is determined by the anatomical location of metastatic lymph nodes (mLNs). However, prognosis can be heterogeneous at the same nodal stage, and the current classification system requires improvement. Therefore, we investigated the correlation between the number of mLNs and prognosis in patients with non-small cell lung cancer. Methods Using a multicenter database in Japan, we retrospectively reviewed the records of patients who underwent complete resection for lung cancer between 2010 and 2016. Kaplan-Meier curves were used to determine recurrence-free and overall survival. Multivariate analyses were performed using the Cox proportional hazards model. Results We included 1,567 patients in this study. We could show a statistically significant difference in recurrence-free survival between pN2 patients with 1 mLN and pN2 patients with ≥2 mLNs (P=0.016). Patients with a combination of pN1 (≥4 mLNs) plus pN2 (1 mLN) had a poorer prognosis than pN1 patients (1-3 mLNs) (P=0.061) and a better prognosis than pN2 patients (≥2 mLNs) patients (P=0.007). Multivariate analysis showed that the number of mLNs was independently associated with cancer recurrence in patients with pN1 and pN2 disease (P=0.034 and 0.018, respectively). Conclusions Nodal classification that combines anatomical location and the number of mLNs may predict prognosis more accurately than the current classification system. Our study provides the concept that supports the subdivision of nodal classification in the upcoming revision of the tumor, node, and metastasis staging system.
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Affiliation(s)
- Joji Samejima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Takuya Nagashima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Daiji Nemoto
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Daisuke Eriguchi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.,Department of Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Minami-ku, Hiroshima, Japan
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24
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Chiappetta M, Lococo F, Leuzzi G, Sperduti I, Petracca-Ciavarella L, Bria E, Mucilli F, Filosso PL, Ratto GB, Spaggiari L, Facciolo F, Margaritora S. External validation of the N descriptor in the proposed tumour-node-metastasis subclassification for lung cancer: the crucial role of histological type, number of resected nodes and adjuvant therapy. Eur J Cardiothorac Surg 2021; 58:1236-1244. [PMID: 32770184 DOI: 10.1093/ejcts/ezaa215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Overlapping survival curves for N1b (multiple N1 stations), N2a2 (single N2 station + N1 involvement) and N2a1 (skip N2 metastasis) limit the current tumour-node-metastasis (TNM) node (N) subclassification for node involvement. We validated externally the proposed subclassification. METHODS Clinical records from a multicentric database comprising 1036 patients with pulmonary adenocarcinoma (ADC) or squamous cell carcinoma with N1/N2 involvement who underwent, from January 2002 to December 2014, complete lung resections were retrospectively reviewed. Patients were categorized according to the 8th TNM N subclassification proposal. Histological type, number of resected nodes (#RN) and adjuvant therapy (ADJ) were considered limiting factors. RESULTS No difference in the 5-year overall survival (-OS) was noted between N1b and N2a1 (49.6% vs 44.8%, P = 0.72); instead, the 5-year-OS was significantly improved in patients with squamous cell carcinoma (63% in N1b vs 30.7% in N2a1, P = 0.04). In patients with ADC, the 5-year-OS was better in those with N2a1 than with N1b (50.6% vs 37.5%, P = 0.09). When we compared N1b with N2a2, the 5-year-OS was statistically significant (49.6% vs 32.8%, P = 0.02); considering only patients with squamous cell carcinoma (63% vs 25.8%, P = 0.003), #RN >10 (63.2% vs 35.3%, P = 0.05) and without ADJ (56.4% vs 24.5%, P = 0.02), the 5-year-OS was significantly different. Differences were not significant for ADC, #RN <10 and ADJ. Finally, the 5-year-OS was statistically significant when we compared N2a1 with N2a2 of the total cohort (44.8% vs 32.8%, P = 0.04), in ADC (5-year-OS 50.6% vs 36.5%, P = 0.04) and #RN >10 (5-year-OS 49.8% vs 32.1%, P = 0.03) without ADJ. CONCLUSIONS Histological type, ADJ and #RN are relevant prognostic factors in N + non-small-cell lung cancer. Considering these results, we may better interpret the prognosis prediction limits of the proposed 8th TNM subclassification for the N descriptor.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Leuzzi
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Leonardo Petracca-Ciavarella
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emilio Bria
- Università Cattolica del Sacro Cuore, Rome, Italy.,Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Felice Mucilli
- Department of General and Thoracic Surgery, University Hospital "SS. Annunziata", Chieti, Italy
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy
| | | | - Lorenzo Spaggiari
- Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy
| | | | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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25
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Song H, Yoon SH, Kim J, Kim J, Lee KW, Lee W, Lee S, Kim K, Lee CT, Chung JH, Lee KH. Application of N Descriptors Proposed by the International Association for the Study of Lung Cancer in Clinical Staging. Radiology 2021; 300:450-457. [PMID: 34060941 DOI: 10.1148/radiol.2021204461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Patients with N1 or N2 non-small cell lung cancer exhibit prognostic heterogeneity. To refine the current N staging system, new N stages were proposed by the International Association for the Study of Lung Cancer. However, those proposed new N stages have not been validated. Purpose To evaluate the prognostic performance of the proposed N descriptors for clinical staging. Materials and Methods Participants with non-small cell lung cancer without distant metastasis from January 2010 to December 2014 were retrospectively included. Each patient's clinical N (cN) stage was assigned to one of seven categories (cN0, cN1a, cN1b, cN2a1, cN2a2, cN2b, cN3). The 5-year overall survival rates were estimated with the Kaplan-Meier method. The adjusted hazard ratios (HRs) and their 95% CIs were estimated by using a multivariable Cox proportional hazard model. Ad hoc analyses according to lymph node (LN) size were performed. Results A total of 1271 patients (median age, 66 years; interquartile range, 59-73 years; 812 men) were included. The 5-year overall survival rates were 77.3%, 53.7%, 36.0%, 29.2%, 34.4%, 18.0%, and 12.4% for stages cN0, cN1a, cN1b, cN2a1, cN2a2, cN2b, and cN3, respectively. Patients with cN2b disease had a worse prognosis than patients with cN2a disease (HR, 1.53; 95% CI: 1.06, 2.22; P = .02). There was no prognostic difference between cN1b and cN1a (HR, 1.13; 95% CI: 0.61, 2.09; P = .71); however, there was a difference between cN1 subgroups when stratified by LN size (≥2 cm; HR, 2.26; 95% CI: 1.16, 4.44; P = .02). Within cN2a disease, there were no differences between cN2a1 and cN2a2 (HR, 0.98; 95% CI: 0.61, 1.56; P = .93) or between subgroups according to LN size (HR, 0.74; 95% CI: 0.40, 1.37; P = .34). Conclusion A survival difference was observed between single- and multistation involvement among cN2 disease. The number of involved lymph node stations in patients with cN1 disease and the presence of skip metastasis in patients with cN2 disease were not associated with survival differences. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Hwayoung Song
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Sung Hyun Yoon
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Junghoon Kim
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Jihang Kim
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Kyoung Won Lee
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Woojoo Lee
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Seungjae Lee
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Kwhanmien Kim
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Choon-Taek Lee
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Jin-Haeng Chung
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
| | - Kyung Hee Lee
- From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea
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Aksoy Y, Çıtak N, Obuz Ç, Metin M, Sayar A. Does anatomical location-based metastatic lymph node density affect prognosis in lung cancer patients? Interact Cardiovasc Thorac Surg 2021; 33:541-549. [PMID: 34000035 DOI: 10.1093/icvts/ivab119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The newly proposed N subclassification (new-N) was compared with the combined anatomical location and ratio of the number of metastatic lymph nodes to the total number of resected lymph nodes (anatomic-LNR) in terms of prognosis in resected lung cancer patients. METHODS Between 2005 and 2018, 961 patients who underwent lung cancer resection were catergorized into the pN1-single (N1a; n = 281), pN1-multiple (N1b; n = 182), pN2-single with skip metastasis (N2a1; n = 116), pN2-single with N1 metastasis (N2a2; n = 222) and pN2-multiple (N2b; n = 160) groups based on new-N. The optimal cut-off points for survival in pN1 and pN2 patients were determined using the best sensitivity and specificity scores, calculated using receiver operating characteristic analysis. RESULTS The difference in survival between N1a and N1b patients was statistically significant (P = 0.001), but there was no significant difference in the survival rates of N1b and N2a1 (P = 0.52). The survival curves for N2a1 and N2a2 patients almost overlapped (P = 0.143). N2a2 patients showed a better survival rate than N2b patients, with no significant difference (P = 0.132). The cut-off points for LNR were 0.10 and 0.25 for pN1 and pN2 patients, respectively, according to receiver operating characteristic analysis for survival. Based on receiver operating characteristic analysis, pN patients were categorized into the N1-lowLNR (n = 232), N1-highLNR (n = 231), N2-lowLNR (n = 266) and N2-highLNR (n = 232) groups. The 5-year survival rate was 62.9%, 49.8%, 41.1% and 27.1% for N1-lowLNR, N1-highLNR, N2-lowLNR and N2-highLNR, respectively (P < 0.001). CONCLUSIONS LowLNR is associated with better survival than highLNR in resected lung cancer patients. Anatomic-LNR shows a high discriminatory power for prognosis.
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Affiliation(s)
- Yunus Aksoy
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Necati Çıtak
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Çiğdem Obuz
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Adnan Sayar
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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27
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Maniwa T, Ohmura A, Hiroshima T, Ike A, Kimura T, Nakamura H, Nakatsuka SI, Okami J, Higashiyama M. Number of metastatic lymph nodes and zones as prognostic factors in non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 31:305-314. [PMID: 32728705 DOI: 10.1093/icvts/ivaa107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/09/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Characterizing pathological nodes (pNs) by location alone is sometimes inadequate as patients with pN1 or pN2 non-small-cell lung cancer (NSCLC) show prognostic heterogeneity. We aimed to assess the relationship of the number of metastatic lymph nodes (LNs) and zones with prognosis in NSCLC patients. METHODS We analysed 1393 patients who underwent lobectomy with mediastinal LN dissection for NSCLC at the Osaka International Cancer Institute between January 2006 and December 2015. Patients were classified into 3 groups according to the number of LNs: n1-3, n4-6 and n7-. We investigated the relationship of prognosis with the number of metastatic LNs and metastatic zones. RESULTS In the multivariable analyses, the number of metastatic LNs and zones were not independent factors for overall survival or recurrence-free survival in patients with pN1 disease after adjustment for age, sex, tumour histology and tumour diameter. However, n4-6 (ref. n1-3) was an independent prognostic factor for overall survival [hazard ratio (HR) 4.148, P < 0.001] in those with pN2 disease. There were no significant differences in overall survival and recurrence-free survival between pN1 (HR 0.674, P = 0.175) and pN2n1-3 disease (HR 1.056, P = 0.808). Moreover, patients with pN2 disease with a higher number of metastatic zones had a poor prognosis for recurrence-free survival [3 zones (ref. 1): HR 1.774, P = 0.051, and 4 zones (ref. 1): HR 2.173, P < 0.047]. CONCLUSIONS The number of metastatic LNs and metastatic zones were useful prognostic factors in NSCLC patients. The findings could help in establishing a new pN classification.
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Affiliation(s)
- Tomohiro Maniwa
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Akiisa Ohmura
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Hiroshima
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Akihiro Ike
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Toru Kimura
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Harumi Nakamura
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Shin-Ichi Nakatsuka
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiko Higashiyama
- Department of General Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan
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Lee K, Jeong YH, Ryu JS, Kim YI, Kim HR, Park SI. Surgical Outcomes of Non-Small Cell Lung Cancer in Single-Zone N2 in the Aortopulmonary Zone. Thorac Cardiovasc Surg 2021; 70:251-257. [PMID: 33882612 DOI: 10.1055/s-0041-1727206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We evaluate the surgical outcome of clinically single-zone N2 lung cancer limited to aortopulmonary zone (AP zone; lymph node #5 or #6). PATIENTS AND METHODS We performed a retrospective analysis of patients with non-small cell lung cancer, in whom mediastinal lymph node metastasis was confined to AP zone. RESULTS A total of 84 patients who underwent upfront surgery were included in final analysis. Among these patients, pathological nodal outcomes were pN0-1 in 27 patients (32.1%), pN2a in 31 (36.9%), and pN2b in 26 (31.0%). In multivariate analysis, adenocarcinoma (p = 0.005) and staging workup without endobronchial ultrasound-transbronchial needle aspiration (p = 0.002) were independent risk factors for unexpected pN2b. The 5-year overall survival (OS) and disease-free survival (DFS) were 55.9 and 54.4%, respectively. There was no survival difference among patients with pN0-1, pN2a, and pN2b (p = 0.717). In survival analysis, there were no significant risk factors for OS. However, female sex and the ratio of positive lymph nodes to removed lymph nodes were significant risk factors for DFS in multivariate analysis (p = 0.032 and p = 0.009). CONCLUSION In this study, cN2a in the AP zone with current diagnostic tool exhibited a relatively high false-positive rate (cN2/pN0-1; 32.1%). However, despite the possibility of pN2b, there were no significant differences in survival outcome according to the pathologic nodal stage.
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Affiliation(s)
- Kanghoon Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Yong Ho Jeong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, Seoul, Korea
| | - Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, Korea
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Chiappetta M, Lococo F, Leuzzi G, Sperduti I, Bria E, Petracca Ciavarella L, Mucilli F, Filosso PL, Ratto G, Spaggiari L, Facciolo F, Margaritora S. Survival Analysis in Single N2 Station Lung Adenocarcinoma: The Prognostic Role of Involved Lymph Nodes and Adjuvant Therapy. Cancers (Basel) 2021; 13:1326. [PMID: 33809513 PMCID: PMC7998125 DOI: 10.3390/cancers13061326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/02/2021] [Accepted: 03/13/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Prognostic factors in patients with single mediastinal station (sN2) involvement continues to be a debated issue. METHODS Data on 213 adenocarcinoma patients with sN2 involvement and who had undergone complete anatomical lung resection and lymphadenectomy, were retrospectively reviewed. Clinical and pathological characteristics together with adjuvant therapy (AD) and node (N) status classifications (number of resected nodes (#RN), number of metastatic nodes (#MN), and node ratio (#MN/#RN = NR) were analyzed. RESULTS Univariable analysis confirmed that age (0.009), #MN (0.009), NR (0.003), #N1 involved stations (p = 0.003), and skip metastases (p = 0.005) were related to overall survival (OS). Multivariable analysis confirmed, as independent prognostic factors, age <66 years and NR with a three-year OS (3YOS) of 78.7% in NR < 10% vs. 46.6% in NR > 10%. In skip metastases, NR (HR 2.734, 95% CI 1.417-5.277, p = 0.003) and pT stage (HR2.136, 95% CI 1.001-4.557, p = 0.050) were confirmed as independent prognostic factors. AD did not influence the OS of patients with singular positive lymph nodes (p = 0.41), while in patients with multiple lymph nodes and AD, a significantly better 3YOS was demonstrated, i.e., 49.1% vs. 30% (p = 0.004). In patients with N2 + N1 involvement, age (p = 0.002) and AD (p = 0.022) were favorable prognostic factors. CONCLUSIONS Adenocarcinoma patients with single N2 station involvement had a favorable outcome in the case of skip metastases and low NR. Adjuvant therapy improves survival with multiple nodal involvement, while its role in single node involvement should be clarified.
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Affiliation(s)
- Marco Chiappetta
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.L.); (E.B.); (L.P.C.); (S.M.)
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Filippo Lococo
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.L.); (E.B.); (L.P.C.); (S.M.)
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giovanni Leuzzi
- Thoracic Surgery, Unit Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Isabella Sperduti
- Biostatistics, Regina Elena National Cancer Institute—IRCCS, 00100 Rome, Italy;
| | - Emilio Bria
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.L.); (E.B.); (L.P.C.); (S.M.)
- Medical Oncology, IRCCS Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
| | - Leonardo Petracca Ciavarella
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.L.); (E.B.); (L.P.C.); (S.M.)
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Felice Mucilli
- Department of General and Thoracic Surgery, University Hospital “SS. Annunziata”, 66100 Chieti, Italy;
| | - Pier Luigi Filosso
- Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, 10126 Turin, Italy;
| | | | - Lorenzo Spaggiari
- Thoracic Surgery Division, European Institute of Oncology, University of Milan, 20141 Milan, Italy;
| | - Francesco Facciolo
- Thoracic Surgery, Regina Elena National Cancer Institute, 00100 Rome, Italy;
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.L.); (E.B.); (L.P.C.); (S.M.)
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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Taber S, Pfannschmidt J, Bauer TT, Blum TG, Grah C, Griff S. Is Adjuvant Radiochemotherapy Always Mandatory in Patients with Resected N2 Non-Small Cell Lung Cancer? Thorac Cardiovasc Surg 2021; 70:244-250. [PMID: 33601469 DOI: 10.1055/s-0041-1723081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients with non-small cell lung cancer (NSCLC), the pathologic union for international cancer control (UICC) stage IIIA is a heterogeneous entity, with different forms of N2-lymph node involvement representing different prognoses. Although a multimodality treatment approach, including surgery, systemic therapy, and/or radiotherapy, is almost always recommended, in this retrospective observational study, we sought to determine whether long-term survival might be possible in selected patients who are treated with complete surgical resection alone. METHODS Between 2013 and 2018, we retrospectively identified 24 patients with NSCLC (16 men and 8 women), who were found to have pathologic N2-lymph node involvement, and were treated with complete surgical lung resection and systematic mediastinal and hilar lymph node dissection but no neoadjuvant or adjuvant treatment. RESULTS The most frequent reason (n = 14) for forgoing adjuvant treatment was patient refusal. The mean overall survival (OS) was 34.5 months (interquartile range [IQR]: 15.5-53.5 months). The mean disease-free survival (DFS) was 18 months (IQR: 4.75-46.75 months). We identified five patients who survived at least 5 years without recurrence (21%). In each of these cases, the nodal metastases were restricted to a single level and no extracapsular lymph node involvement were detected. Additionally, worse DFS was associated with pT3/4 (vs. a lower T-stage), as well as microscopic lymphovascular invasion. CONCLUSION Although the small sample size precludes any definitive conclusions, it was possible to demonstrate that long-term survival without neoadjuvant and adjuvant treatment is possible in some patients if complete tumor and nodal resection is performed.
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Affiliation(s)
- Samantha Taber
- Department of Thoracic Surgery, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Torsten G Blum
- Department of Pneumology, Lung Clinic Heckeshorn, HELIOS Emil von Behring, Berlin, Germany
| | - Christian Grah
- Department of Internal Medicine and Respiratory Medicine, Gemeinschaftskrankenhaus Havelhohe gGmbH, Berlin, Germany
| | - Sergej Griff
- Department of Pathology, Institute of Pathology, HELIOS Klinikum Emil von Behring GmbH, Berlin, Germany.,Department of Pathology, Brandenburg Medical School Theodor Fontane, Neuruppin, Brandenburg, Germany
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Li S, Yan S, Lu F, Lv C, Wang Y, Li X, Wang Y, Yang Y, Wu N. Validation of the 8th Edition Nodal Staging and Proposal of New Nodal Categories for Future Editions of the TNM Classification of Non-Small Cell Lung Cancer. Ann Surg Oncol 2021; 28:4510-4516. [PMID: 33389296 DOI: 10.1245/s10434-020-09461-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The International Association for the Study of Lung Cancer (IASLC) N classifications, which depend on the location and involvement of the lymph nodes, provide accurate prognoses. This study validated the efficiency of classifications using a single-institution dataset and proposed a modified system based on 5-level N1 node dissection. METHODS From January 2005 to December 2014, 1851 patients with completely resected non-small cell lung cancer were reviewed. According to the IASLC recommendations, N1 is further subdivided into N1a (single) and N1b (multiple), N2 is divided into N2a1 (single station without N1), N2a2 (single station with N1), and N2b (multiple station). Additionally, we evaluated dividing N0 into N0a (with level 13/14 examination) and N0b (without level 13/14 examination), and N1 into N1a* (only level 13/14 positive) and N1b* (level 10-12 positive). Overall survival was also compared. RESULTS Multivariate analysis showed that the N classifications recommended by the IASLC and those proposed and evaluated by this study could both significantly predict the prognoses of patients (p < 0.001, respectively). There was no significant difference in survival between N1b and N1a (hazard ratio [HR] 1.049, p = 0.83) and N2a1 and N1b (HR 1.314, p = 0.261); however, there were significant differences between N0a and N0b (HR 1.778, p < 0.001) and N1a* and N1b* (HR 2.014, p = 0.019). The survival curve of N1a* overlapped N0b (HR 0.997, p = 0.991), and N2a1 overlapped N1b* (HR 0.842, p = 0.444). CONCLUSION More detailed nodal information is required to facilitate future revisions of N staging.
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Affiliation(s)
- Shaolei Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Fangliang Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chao Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yaqi Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yuzhao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China.
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Xu L, Su H, She Y, Dai C, Zhao M, Gao J, Xie H, Ren Y, Xie D, Chen C. Which N Descriptor Is More Predictive of Prognosis in Resected Non-small Cell Lung Cancer: The Number of Involved Nodal Stations or the Location-Based Pathological N Stage? Chest 2020; 159:2458-2469. [PMID: 33352193 DOI: 10.1016/j.chest.2020.12.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The eighth edition of nodal classification for non-small cell lung cancer (NSCLC) is defined only by the anatomical location of metastatic lymph nodes. RESEARCH QUESTION We sought to evaluate the prognostic significance and discriminatory capability of the number of involved nodal stations (nS) in a large Chinese cohort. STUDY DESIGN AND METHODS A total of 4,011 patients with NSCLC undergoing surgical resection between 2009 and 2013 were identified. The optimal cutoff values for nS classification were determined with X-tile software. Kaplan-Meier and multivariate Cox analysis were used to examine the prognostic performance of nS classification in comparison with location-based N classification. A decision curve analysis was performed to evaluate the standardized net benefit of nS classification in predicting prognosis. RESULTS All the patients were classified into four prognostically different subgroups according to the number of involved nodal stations: (1) nS0 (none positive), (2) nS1 (one involved station), (3) nS2 (two involved stations), and (4) nS ≥ 3 (three or more involved stations). The prognoses among all the neighboring categories of nS classification were statistically significantly different in terms of disease-free survival and overall survival. The multivariate Cox analysis demonstrated that nS was an independent prognostic factor of disease-free survival and overall survival. Patients with N1 or N2 stage disease could be divided into three prognostically different subgroups according to nS classification. However, the prognosis was similar between the N1 and N2 subgroups when patients were staged in the same nS category. The decision curve analysis showed that nS classification tended to have a higher predictive capability than location-based N classification. INTERPRETATION The nS classification could be used to provide a more accurate prognosis for patients with resected NSCLC. The nS is worth taking into consideration when defining nodal category in the forthcoming ninth edition of the staging system.
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Affiliation(s)
- Long Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiani Gao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yijiu Ren
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Incorporating the Number of PLN into the AJCC Stage Could Better Predict the Survival for Patients with NSCLC: A Large Population-Based Study. JOURNAL OF ONCOLOGY 2020; 2020:1087237. [PMID: 33381175 PMCID: PMC7748903 DOI: 10.1155/2020/1087237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022]
Abstract
Purpose This study aimed to investigate the application of the number of positive lymph nodes (PLNs) in tumor, node, metastasis (TNM) staging system of non-small cell lung cancer (NSCLC) patients. Patients and Methods. We screened a total of 15820 patients with resected NSCLC between 2004 and 2015 from SEER database. The X-tile model was used to determine the cutoff values of the number of PLNs. Overall survival (OS) curves were plotted using the Kaplan–Meier method, and the differences among the individual groups were defined using the log-rank test. Cox regression model was used to perform univariate and multivariate analyses and to assess the association between the number of PLNs and OS. Results In this study, using the X-tile model, we screened three different cutoff values, including nN0, nN1–3, and nN4-. Survival curves demonstrated that our defined nN stage had a significant predictive value for OS (P < 0.001). In the univariate and multivariate Cox analyses, the result showed that nN stage was a significant prognostic factor of OS for NSCLC patients (P < 0.001). Subsequently, we classified the patients into five subgroups based on the combination of pN and nN stages, including pN0 + nN0, pN1 + nN1-3, pN2 + nN1-3, pN1 + nN4-, and pN2 + nN4-. Moreover, survival curves revealed significant differences among these five groups (P < 0.001). Conclusion A combination of pathological LNs (pN) and the number of LN (nN) involvement in NSCLC patients had a better prognostic value than the current TNM staging system based on only pN stage.
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Tsitsias T, Okiror L, Veres L, King J, Harrison-Phipps K, Routledge T, Pilling J, Bille A. New N1/N2 classification and lobe specific lymphatic drainage: Impact on survival in patients with non-small cell lung cancer treated with surgery. Lung Cancer 2020; 151:84-90. [PMID: 33250210 DOI: 10.1016/j.lungcan.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE to validate the proposed N descriptor revision on a large cohort of patients and assess the impact of tumour location on the distribution pattern of lymph node metastases for patients with NSCLC. METHODS This is a retrospective review of a consecutive series of patients who had anatomical lung resections. Systematic lymph node dissection was done for all patients. RESULTS Between January 2009 and December 2019 2566 patients had surgical resection for NSCLC. 448 patients (17.5%) had histologically confirmed lymph node metastases: 257 (57.4 %) had pN1 and 191 pN2. Median age of the study population was 69.1 years. Overall survival (OS) for study population was 37.3 months with 5-year survival rate of 35.7 %. The survival analysis of the N subgroups showed the pN2 patients had a median OS of 27.9 months vs. 41.7 months for pN1 patients (p = 0.013). Analysis as per the new proposal of the N subgroups N1a vs N1b vs N2a1 vs N2a2 vs N2b showed that median survival OS was 41.7 vs. 39.2 mo vs. 33.3 mo vs. 28.9 mo vs. 24.6 mo (p = 0.099). There was statistically significant difference in survival between N2 patients with skip metastasis and N2 patients without skip metastases: OS 32.2 (95 % CI: 16.8-47.6) months vs. 24.2 months (p = 0.024). On multivariate analysis only pathological N (p = 0.011) and the new proposed N classification (p = 0.006) were independent prognostic factors for survival. CONCLUSIONS N1 and N2 disease are heterogeneous groups and require further stratification. The number of N2 lymph node stations involved and the presence or not of N1 disease translated to significant differences in survival and therefore have to be included in N staging.
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Affiliation(s)
- Thomas Tsitsias
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Lawrence Okiror
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Lukacs Veres
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Juliet King
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | | | - Tom Routledge
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - John Pilling
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom; Division of Cancer Studies, King's College London, Guy's Hospital, London, United Kingdom.
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Cackowski MM, Gryszko GM, Zbytniewski M, Dziedzic DA, Orłowski TM. Alternative methods of lymph node staging in lung cancer: a narrative review. J Thorac Dis 2020; 12:6042-6053. [PMID: 33209438 PMCID: PMC7656442 DOI: 10.21037/jtd-20-1997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The nodal status indicator in non-small cell lung cancer is one of the most crucial prognostic factors available. However, there are still many arguments among scientists regarding whether the currently used nodal status descriptor should be changed in the forthcoming editions of the Tumor Node Metastasis classification or whether it is precise enough and should be maintained as is. We reviewed studies concerning nodal factor classifications to evaluate their accuracy in non-small cell lung cancer patients and to address the previously mentioned challenge. We reviewed the PubMed database regarding the following classifications: ongoing 8th edition of the Tumor Node Metastasis classification, number of positive lymph nodes, number of negative lymph nodes, number of dissected lymph nodes, lymph node ratio, nodal chains, log odds of positive lymph nodes, zone-based classification and one that is based on the number of lymph node stations involved. Moreover, we analysed data regarding various combinations of these classifications. Our analysis showed that the present nodal staging may not accurately categorize every lung cancer patient. The number of positive lymph nodes and lymph node ratio or the log odds of positive lymph nodes (as the mathematical modification of lymph node ratio) are more legitimate, as they possess very robust data and should be considered initially as additional factors that can be incorporated in ongoing nodal staging systems. Forthcoming non-small cell lung cancer staging systems could benefit from the addition of quantitative-based parameters. Additionally, the minimal extent of lymphadenectomy should be established as staging benefits from it. International, prospective validation studies need to be performed to optimize the cut-off values and prognostic groups and to confirm the superiority of the newly suggested descriptors in non-small cell lung cancer nodal staging.
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Affiliation(s)
- Marcin M Cackowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Grzegorz M Gryszko
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Marcin Zbytniewski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Dariusz A Dziedzic
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
| | - Tadeusz M Orłowski
- Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland
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Xing H, Hu M, Chen J, Guo Y, Liu D, Liang C. Combining node location and node ratio as a prognostic factor for surgical resected non-small cell lung cancer: a population-based study. J Thorac Dis 2020; 12:3549-3560. [PMID: 32802434 PMCID: PMC7399421 DOI: 10.21037/jtd-20-758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background In the TNM system only the anatomic location is used to define nodal status. In this study we aim to evaluate the effectiveness of combining the location and ratio of metastatic lymph node (pN-NR) for the prognosis of non-small cell lung cancer (NSCLC). Methods Patients with pN1/pN2 NSCLC were retrieved from the SEER database. The optimal cut point of NR was determined with the maximal selecting test. All patients were divided into 4 categories with combination of pN (pN1 or pN2) and NR (low or high). The pN-NR was investigated as a predictor of overall survival (OS) and cause-specific survival (CSS) using Cox regression models. Survival curves were plotted using the Kaplan-Meier method and the difference was compared with log-rank test. Results A total of 12,170 patients were enrolled. The optimal cut point of NR was 0.3. Patients were divided into 4 groups: pN1-NR <0.3, pN1-NR ≥0.3, pN2-NR <0.3 and pN2-NR ≥0.3. The pN-NR was an independent prognostic factor for survival. Compared with pN1-NR <0.3, the hazard ratio of OS was 1.405 (95% CI: 1.295-1.524), 1.183 (95% CI: 1.113-1257) and 1.717 (95% CI: 1.607-1.835) times higher for pN1-NR ≥0.3, pN2-NR <0.3 and pN2-NR ≥0.3 group, respectively. The survival curves of OS separated well between the 4 pN-NR groups, with 5-year OS 47.1% for pN1-NR <0.3, 43.0% for pN2-NR <0.3, 35.0% for pN1-NR ≥0.3 and 28.5% for pN2-NR ≥0.3, and the P value between neighboring curves was statistically significantly. The same trend was observed for CSS. Subgroup analysis revealed similar results except the pneumonectomy group. Conclusions pN-NR could be a good predictor for the prognosis of NSCLC.
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Affiliation(s)
- Huajie Xing
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Mengyu Hu
- Department of Breast Oncology, Beijing Cancer Hospital, Beijing, China
| | - Jingyu Chen
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yongqing Guo
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China
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Yu Y, Zhang P, Yao R, Wang J, Wang P, Xue X, Xiao J, Wang Z. Prognostic value of log odds of positive lymph nodes in node-positive lung squamous cell carcinoma patients after surgery: a SEER population-based study. Transl Lung Cancer Res 2020; 9:1285-1301. [PMID: 32953505 PMCID: PMC7481584 DOI: 10.21037/tlcr-20-193] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Log odds of positive lymph nodes (LODDS) is a novel and promising ratio-based lymph node (LN) staging system in many malignancies. This study aimed to evaluate the prognostic value of LODDS, and comprehensively compare the prognostic predictive performance of LODDS with the American Joint Committee on Cancer (AJCC) N classification, number of positive lymph node (NPLN), and lymph node ratio (LNR) among node-positive lung squamous cell carcinoma (SCC) patients after surgery. Methods We identified 2,561 patients with N1/N2 stage SCC diagnosed between 2004 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. X-tile analysis was used to calculate the optimal cut-off value for each staging system. Univariable and Multivariable Cox regression analyses were used to assess the association of cancer-specific survival (CSS), and overall survival (OS) with N, NPLN, LNR, and LODDS, separately, and integrally. Moreover, linear trend χ2 score, likelihood ratio (LR) test, Akaike information criterion (AIC), and Harrell concordance index (C-index) were adopted as criteria for assessing the predictive ability of each model. Results The optimal cut-off values for NPLN, LNR, and LODDS were 3, 0.28, and −0.37, respectively. N, NPLN, LNR, and LODDS were identified as independent prognostic predictors for CSS and OS in patients with SCC when each of them was incorporated into multivariable Cox model separately. Additionally, LODDS had the higher linear trend χ2 score, higher LR χ2 test score, lower AIC, and higher C-index compared to the other three systems. Moreover, a combination of N, NPLN, and LODDS was superior to any staging system alone for predicting prognosis. Conclusions LODDS showed better predictive performance than N, NPLN, and LNR among patients with node-positive SCC after surgery. A combination of LODDS and the current AJCC TNM classification has the potential for becoming a better staging method to more precisely predicting prognosis.
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Affiliation(s)
- Yue Yu
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Peng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Renqi Yao
- Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China.,Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Junnan Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.,Medical Research Center of War Injuries and Trauma, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Pei Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xiaofei Xue
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jian Xiao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
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Sanz-Santos J, Call S. Preoperative staging of the mediastinum is an essential and multidisciplinary task. Respirology 2020; 25 Suppl 2:37-48. [PMID: 32656946 DOI: 10.1111/resp.13901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022]
Abstract
Mediastinal staging is a crucial step in the management of patients with NSCLC. With the recent development of novel techniques, mediastinal staging has evolved from an activity of interest mainly for thoracic surgeons to a joint effort carried out by many specialists. In this regard, the debate of cases in MDT sessions is crucial for optimal management of patients. Current evidence-based clinical guidelines for preoperative NSCLC staging recommend that mediastinal staging should be performed with increasing invasiveness. Image-based techniques are the first approach, although they have limited accuracy and findings must be confirmed by pathology in almost all cases. In this setting, the advent of radiomics is promising. Invasive staging depends on procedural factors rather than diagnostic performance. The choice between endoscopy-based or surgical procedures should depend on the local expertise of each centre. As the extension of mediastinal disease in terms of number of involved lymph nodes and nodal stations affects prognosis and the choice of treatment, systematic samplings are preferred over random targeted samplings. Following this approach, a diagnosis of single mediastinal nodal involvement can be unreliable if all reachable mediastinal nodal stations have not been assessed. The performance of confirmatory mediastinoscopy after a negative endoscopy-based procedure is controversial but currently recommended. Current indications of invasive staging in patients with radiologically normal mediastinum have to be re-evaluated, especially for central tumour location.
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Affiliation(s)
- José Sanz-Santos
- Department of Pulmonology, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.,Department of Medicine, Medical School, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Spain
| | - Sergi Call
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain.,Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Cerdanyola, Spain
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Kojima H, Terada Y, Yasuura Y, Konno H, Mizuno T, Isaka M, Funai K, Ohde Y. Prognostic impact of the number of involved lymph node stations in patients with completely resected non-small cell lung cancer: a proposal for future revisions of the N classification. Gen Thorac Cardiovasc Surg 2020; 68:1298-1304. [PMID: 32449108 DOI: 10.1007/s11748-020-01389-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/12/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The current nodal staging for lung cancer is defined only by the anatomical site of metastasis. However, the International Association for the Study of Lung Cancer (IASLC) proposed further subdivisions of the N descriptor that considers the locations and numbers of involved lymph node stations. This study aimed to test the new IASLC categories and compare their prognostic abilities to those of our proposed model that considers only the number of involved lymph node stations instead of the sites of metastasis. METHODS Between September 2002 and December 2016, 1581 patients who underwent complete resection for pathologically diagnosed Tis-4N0-2M0 non-small cell lung cancer were retrospectively analyzed. We evaluated the survival rates according to the patients' N classification as recently proposed by the IASLC and by the number of involved lymph node stations, and determined the optimal N classification. RESULTS The 5-year survival rates for patients with IASLC stages N1a, N1b, N2a1, N2a2, and N2b were 71.5%, 49.9%, 73.7%, 62.1%, and 46.9%, respectively. These results showed relatively good categorizations; however, some prognostic overlaps existed and not all differences were significant. After redefining the number of involved stations as Nα for 1, Nβ for 2-3, and Nγ for ≥ 4 without considering the metastasis sites, the 5-year survival rates for patients in these categories were 72.1%, 58.3%, and 29.6%, respectively; the differences between them were significant. CONCLUSION The number of involved lymph node stations is a more accurate prognostic indicator in patients with completely resected non-small cell lung cancer.
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Affiliation(s)
- Hideaki Kojima
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
| | - Yukihiro Terada
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yoshiyuki Yasuura
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hayato Konno
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tetsuya Mizuno
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Shi S, Xie H, Yin W, Zhang Y, Peng X, Yu F, Shemanski KA, Kim AW, Wang X. The prognostic significance of the 8th edition AJCC TNM staging system for non-small-cell lung cancer is not applicable to lung cancer as a second primary malignancy. J Surg Oncol 2020; 121:1233-1240. [PMID: 32170977 DOI: 10.1002/jso.25903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES It is unclear whether the prognostic significance of the 8th American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging system for non-small-cell lung cancer (NSCLC) is applicable to lung cancer as a second primary malignancy (LCSPM). This study used a population-based database to evaluate this relationship. METHODS Patients diagnosed with second primary lung cancer after a nonpulmonary malignancy were identified from the Surveillance, Epidemiology and End Results (SEER) registry from 2004 to 2015. Cumulative incidence function (CIF) and multivariable CIF regression analyses were performed to estimate the difference in disease-specific mortality (DSM) among different TNM stages. RESULTS Our cohort included 2687 patients from the SEER database. After CIF analysis, although rates of 1-year, 3-year, and 5-year DSM trended higher with increasing TNM stages, the DSM curves overlapped for many subcategories. In a multivariable regression analysis, hazards ratios (HRs) for subcategories of stage Ι demonstrated no significant difference compared with the reference stage ΙA1 ([ΙA2 HR = 1.120; 95% confidence interval [CI], 0.477-2.626]; [ΙA3 HR = 1.762; 95% CI, 0.752-4.126]; [ΙB HR = 2.003; 95% CI, 0.804-4.911]). The following HRs trended higher for increasing TNM stages but with overlapping CIs among adjacent stage groupings. CONCLUSION The 8th edition AJCC TNM staging system fails to provide accurate prognostic value for LCSPM.
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Affiliation(s)
- Shuai Shi
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Xie
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Yin
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuqian Zhang
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiong Peng
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fenglei Yu
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kimberly A Shemanski
- Department of Surgery, Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Anthony W Kim
- Department of Surgery, Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Xiang Wang
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Wang L, Ye G, Xue L, Zhan C, Gu J, Xi J, Lin Z, Jiang W, Ge D, Wang Q. Skip N2 Metastasis in Pulmonary Adenocarcinoma: Good Prognosis Similar to N1 Disease. Clin Lung Cancer 2020; 21:e423-e434. [PMID: 32245623 DOI: 10.1016/j.cllc.2020.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/08/2019] [Accepted: 02/29/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The prognostic effect and mechanism of skip N2 lung cancer remain unclear. Our study aimed to elucidate the influence of skip N2 on overall survival (OS) and disease-free survival (DFS) compared with N1 and non-skip N2 in patients with lung adenocarcinoma. PATIENTS AND METHODS Patients with lung adenocarcinoma and lymph node involvement between May 2011 and December 2015 were retrospectively analyzed. The outcomes of skip N2 patients were compared with N1 and non-skip N2 patients. Prognosis was further investigated according to the N status in different adenocarcinoma subtypes. Univariate and multivariate analyses were carried out to define independent risk factors for OS and DFS. RESULTS A total of 456 patients with lung adenocarcinoma, 169 with N1 disease, 81 with skip N2 disease, and 206 with non-skip N2 disease, were enrolled in this study. All tumors were invasive adenocarcinoma, and the predominant subtypes were acinar in 252, papillary in 42, solid in 119, micropapillary in 20, and invasive mucinous adenocarcinoma in 23 patients. The DFS and OS of N1 and skip N2 diseases were similar and significantly better than those of patients with non-skip N2 disease. The prognosis according to lymph node status was significantly different in acinar-predominant subtypes in terms of both OS and DFS. CONCLUSIONS Skip N2 disease has a similar prognosis to N1 disease and is significantly better than that of non-skip N2 disease in relation to OS and DFS. Skip N2 has a prognostic advantage in patients with the acinar-predominant subtype.
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Affiliation(s)
- Lin Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guanzhi Ye
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Xue
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Gu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjie Xi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Di Ge
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Wang J, Wu N, Lv C, Yan S, Yang Y. Recommended changes for the 8th edition of the TNM classification for lung cancer-the findings of a single-institution evaluation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:123. [PMID: 32175416 PMCID: PMC7048979 DOI: 10.21037/atm.2020.01.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To evaluate the efficacy of the nodal descriptors and subgroups proposed by International Association for the Study of Lung Cancer (IASLC) in the 8th edition of the TNM classification system and to provide references for future editions. METHODS A total of 3,177 patients with non-small cell lung cancer at the Beijing Cancer Hospital were classified based on the following three methods: (I) the N descriptors in the 8th edition of the TNM classification system: N0, N1, N2, and N3; (II) the IASLC-proposed N subgroups: N1a, N1b, N2a1, N2a2, and N2b; (III) our more extensive division method: N1a, N1b, N1c, N2a1, N2a2, N2b1, N2b2, N2c, N3a, and N3b. Five-year survival analysis was performed using the Kaplan-Meier method, and differences between subgroups were evaluated using the log-rank test. RESULTS (I) A significant survival difference was found between each adjacent N descriptor; (II) the difference between each adjacent subgroup N descriptor was significant, but the difference between N1b and N2a1 was not; (III) in our proposed method, a significant difference was found between all the subgroups apart from N2a2 and N2b1, N2b1 and N2b2, N2c and N3a, and N3a and N3b. CONCLUSIONS The N descriptors in the 8th edition of the tumor, node, and metastasis (TNM) classification system are consistent with our data. Although our more extensive division method could distinguish between patients at different stages, its implementation is complicated; thus, we recommend the implementation of the IASLC-proposed subgroups with the addition of the N1b and N2a1 groups.
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Affiliation(s)
- Jia Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Chao Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Zhang S, Wang L, Lu F, Pei Y, Yang Y. [Correlation between Lymph Node Ratio and Clinicopathological Features and Prognosis of IIIa-N2 Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:702-708. [PMID: 31771739 PMCID: PMC6885420 DOI: 10.3779/j.issn.1009-3419.2019.11.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND IIIa-N2 non-small cell lung cancer was significant different in survival, although N stage of lung cancer based on anatomic location of metastasis lymph node. Lymph node ratio considered of prognostic factor might be the evaluation index for IIIa-N2 non-small cell lung cancer prognosis. Therefore, the aim of the study was to evaluate the correlation between lymph node ratio and clinicopathological features and prognosis of IIIa-N2 non-small cell lung cancer prognosis. METHODS A total of 288 cases of pathological IIIa-N2 non-small cell lung cancer were enrolled who received radical resection at the Department of Thoracic Surgery II, Peking University Cancer Hospital from January 2006 to December 2016. The univariate analysis between clinicopathological variables and lymph node ratio used Pearson's chi-squared test. Cox regression was conducted to identify the independent prognosis factors for IIIa-N2 non-small cell lung cancer. RESULTS There were 139 cases in the lower lymph node ratio group, another 149 cases in the higher lymph node ratio group. Adenocarcinoma (χ²=5.924, P=0.015), highest mediastinal lymph node metastasis (χ²=46.136, P<0.001), multiple-number N2 metastasis (χ²=59.347, P<0.001), multiple-station N2 metastasis (χ²=77.387, P<0.001) and skip N2 lymph node metastasis (χ²=61.524, P<0.001) significantly impacted lymph node ratio. The total number of lymph node dissection was not correlated with the lymph node ratio (χ²=0.537, P=0.464). Cox regression analysis confirmed that adenocarcinoma (P=0.008), multiple-number N2 metastasis (P=0.025) and lymph node ratio (P=0.001) were the independent prognosis factors of disease free survival. The 5-year disease free survival was 18.1% in the higher lymph node ratio group, and 44.1% in the lower. Lymph node ratio was the independent prognosis factor of overall survival (P<0.001). The 5-year overall survival was 36.7% in the higher lymph node ratio group, and 64.1% in the lower. CONCLUSIONS Lymph node ratio was correlative with the pathology, highest mediastinal lymph node metastasis, multiple-number N2 metastasis, multiple-station N2 metastasis and skip N2 lymph node metastasis. Lymph node ratio was the independent prognosis factor for IIIa-N2 non-small cell lung cancer.
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Affiliation(s)
- Shanyuan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Liang Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Fangliang Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yuquan Pei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing 100142, China
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Citak N, Aksoy Y, Isgörücü Ö, Obuz C, Acikmese B, Buyukkale S, Metin M, Sayar A. A Comparison of the Currently Used Nodal Stage Classification with the Number of Metastatic Lymph Nodes and the Number of Metastatic Lymph Node Stations for Non-Small Cell Lung Cancer; Which of These Is the Best Prognostic Factor? Zentralbl Chir 2019; 145:565-573. [DOI: 10.1055/a-1008-9598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Objectives We aimed to compare the currently used nodal staging system (pN) with the number of metastatic lymph node (LN) stations (sN) and the number of metastatic LNs (nN) on survival in patients with NSCLC.
Methods Between 2010 and 2017, 1038 patients resected for NSCLC were analyzed. We performed three-different stratifications of LN status assessment: pN-category (pN0, pN1 and pN2); sN-category (sN0, sN1; one station metastasis, sN2; two-three stations metastases, and sN3; ≥ 4 stations metastasis); nN-category (nN0, nN1; one-three LNs metastasis, nN2; four-six Lns metastasis, and nN3; ≥ 7 LNs metastasis).
Results Five-year survival rate was 70.1% for N0 in all classifications. It was 54.3% for pN1, and 26.4% for pN2 (p < 0.0001). Five-year survival rates for N1, N2, and N3 categories were 54.1%, 42.4% and 16.1% according to sN, and 51.4%, 36.1%, and 7.9% according to nN, respectively (p < 0.0001). In multivariate analysis, sN and nN were independent risk factors such as pN (p < 0.0001). Hazard ratios versus N0 for N1, N2, and N3 were more significant for sN and nN than pN (1.597, 2.176, and, 3.883 for sN, 1.645, 2.658, and, 4.118 for nN, and 1.576, 3.222 for pN, respectively). When the subcategories of sN and nN were divided into pN1 and pN2 subgroups, the anatomic location of the LN involvement lost importance as tumor burden and tumor spreading increased.
Conclusion The number of metastatic LN stations and the number of metastatic LNs are better prognostic factors than currently used nodal classification in NSCLC.
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Affiliation(s)
- Necati Citak
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yunus Aksoy
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Özgür Isgörücü
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Obuz
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Baris Acikmese
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Songul Buyukkale
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Adnan Sayar
- Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Eichhorn F, Klotz LV, Muley T, Kobinger S, Winter H, Eichhorn ME. Prognostic relevance of regional lymph-node distribution in patients with N1-positive non-small cell lung cancer: A retrospective single-center analysis. Lung Cancer 2019; 138:95-101. [PMID: 31678832 DOI: 10.1016/j.lungcan.2019.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/03/2019] [Accepted: 10/16/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Lymph node (LN) metastases predict survival in patients with non-small cell lung cancer (NSCLC) treated with curative surgery. Nevertheless, prognostic differences within the same nodal (N) status have been reported. Consequently, the International Association for the Study of Lung Cancer (IASLC) proposed to stratify patients with limited nodal disease (pN1) from low (pN1a) to high (pN1b) nodal tumor burden. This study aimed to validate the IASLC proposal in a large single-center surgical cohort of patients with pN1 NSCLC. MATERIAL AND METHODS Data from 317 patients with pN1 NSCLC treated between January 2012 and December 2016, were retrospectively analyzed. Associations between distribution of LN metastases and survival were analyzed for different classification models-toward nodal extension (pN1a: one station involved; pN1b: multiple stations involved) and toward location (pN1 in the hilar [LN#10/11] or peripheral zone [LN#12-14]). RESULTS Tumor-specific survival (TSS) in the entire pN1 cohort was 67.1% at five years. Five-year TSS rates for pN1a and pN1b patients were comparable (67.6% vs. 66.5%, p = 0.623). Significant survival differences from pN1a to pN1b were observed only in patients with adenocarcinoma histology and completed adjuvant chemotherapy (5-year TSS: pN1a, 80.4% vs. pN1b, 49.6%; p = 0.005). TSS for LN metastases in the hilar zone/peripheral zone or in both zones was 68.2% and 59.9%, respectively (p = 0.068). In multivariate analysis, adjuvant chemotherapy, squamous cell histology, and nodal disease limited to one zone nodal disease were identified as independent beneficial prognostic factors (p < 0.05). CONCLUSION pN1 in only one region (hilar or lobar) was associated with better outcome than metastatic affection of both regions after surgery and adjuvant therapy. A stratification towards single (pN1a) and multiple (pN1b) N1-metastases was found of prognostic relevance only in adenocarcinoma. Prospective multicenter analysis of prognostic subgroups in N1 NSCLC is required to evaluate its clinical impact for consideration in future TNM classification.
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Affiliation(s)
- F Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany.
| | - L V Klotz
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - T Muley
- Section Translational Research (STF), Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - S Kobinger
- Section Translational Research (STF), Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - H Winter
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
| | - M E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany; Translational Lung Research Center (TLRC), Heidelberg, Member of the German Center for Lung Research (DZL), Germany
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Griff S, Taber S, Bauer TT, Pfannschmidt J. Prognostic significance of the pattern of pathological N1 lymph node metastases for non-small cell lung cancer. J Thorac Dis 2019; 11:3449-3458. [PMID: 31559050 DOI: 10.21037/jtd.2019.07.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In patients with non-small cell lung cancer (NSCLC) the pathologic lymph node status N1 is a heterogeneous entity, and different forms of lymph node involvement may represent different prognoses. For methodological reasons, the 8th edition of the TNM staging system for NSCLC makes no official changes to the N descriptor. However, there is evidence that different subforms of N1 disease are associated with different prognoses, and it is now recommended that clinicians record the number of affected lymph nodes and nodal stations for further analyses. In this investigation we sought to determine whether patients with different levels and types of N1 lymph node involvement had significantly different 5-year survival rates. Methods We retrospectively identified 90 patients with NSCLC (61 men, 29 women), who were treated between 2008 and 2012 and found to have pathologic N1 lymph node involvement and tumor sizes corresponding to T1 or T2. All patients were treated in curative intent with surgical lung resection and systematic mediastinal and hilar lymph node dissection. Results The overall 5-year survival rate was 56.3%. In the univariate analysis, lower tumor stage and tumor histology other than large-cell carcinoma were significantly associated with better long-term survival. Patients with solitary lymph node metastases also had longer disease-free survival than those with multiple nodal metastases. In the multivariate analysis, large-cell carcinoma and Union for International Cancer Control (UICC) stage IIB were independently associated with worse survival, while pneumonectomy, compared to lobar or sublobar resection, was independently associated with better survival. Conclusions Although we did not observe significant prognostic differences between N1 subcategories within our patient population, other analyses may yield different results. Therefore, these data highlight the need for large, well-designed multicenter studies to confirm the clinical significance of N1 subcategories.
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Affiliation(s)
- Sergej Griff
- Institute of Pathology, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Samantha Taber
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Torsten T Bauer
- Department of Pneumology, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
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Pfannschmidt J, Kollmeier J. Ergebnisse der N1- und N2-Chirurgie beim nichtkleinzelligen Lungenkarzinom. Chirurg 2019; 90:974-981. [DOI: 10.1007/s00104-019-01029-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Park BJ, Kim TH, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho JH. Recommended Change in the N Descriptor Proposed by the International Association for the Study of Lung Cancer: A Validation Study. J Thorac Oncol 2019; 14:1962-1969. [PMID: 31442497 DOI: 10.1016/j.jtho.2019.07.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/15/2019] [Accepted: 07/26/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The International Association for the Study of Lung Cancer recently proposed a new N descriptor by combining the location of metastatic lymph nodes (LNs), nN (single-station versus multiple-station), and absence versus presence of skip metastasis as pN1a, pN1b, pN2a1, pN2a2 and pN2b. This study aimed to evaluate the discriminatory ability and prognostic performance of the proposed N descriptor in a large independent NSCLC cohort. METHODS We analyzed 1228 patients who underwent major pulmonary resection for pathological N1 or N2 NSCLC between 2004 and 2014. Survival analysis using the Cox proportional hazard model was performed to assess the prognostic significance of the N descriptor. RESULTS From 2004 to 2014, a total of 7437 patients were operated on for NSCLC. Patients pathologically confirmed as having N1 (n = 732) or N2 (n = 496) disease after surgery were included. The median total number of dissected LNs was 24 (range 10-83), and the median number of involved LNs was 2 (range 1-40). The 5-year overall survival rates were 62.6%, 57.0%, 64.7%, 48.4%, and 42.8% for stages N1a, N1b, N2a1, N2a2, and N2b, respectively. Analysis of overall and recurrence-free survival revealed that N2a1 is not sufficiently distinguished from N1a and N1b. In terms of overall survival, N1b is not sufficiently distinguished from N2a2. CONCLUSION On the basis of the N descriptor proposed by the International Association for the Study of Lung Cancer, some of the prognostic implications of the five groups overlapped. It would be better to classify similar prognostic groups into three or four groups to divide the group. A large-scale prospective study is needed to validate these N descriptors.
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Affiliation(s)
- Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Chen W, Zhang C, Wang G, Yu Z, Liu H. Feasibility of nodal classification for non-small cell lung cancer by merging current N categories with the number of involved lymph node stations. Thorac Cancer 2019; 10:1533-1543. [PMID: 31207184 PMCID: PMC6610263 DOI: 10.1111/1759-7714.13094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction The aim of this study was to assess the prognoses of patients with non‐small cell lung cancer (NSCLC) according to the current nodal (N) categories of the tumor, node and metastasis (TNM) classification and the number of involved lymph node stations. Methods Five hundred and seventy patients with NSCLC underwent surgery from 1 January 2005 to 31 December 2009 and were analysed retrospectively. Postoperative overall survival was analysed according to two nodal classifications: the current N0, N1, N2 and N3 categories and those based on the number of involved nodal stations: N0, N1a (single N1), N1b (multiple N1), N2a1 (single N2 without N1), N2a2 (single N2 with N1), N2b1 (multiple N2 without N1) and N2b2 (multiple N2 with N1). Results Five‐year survival rates were 76.1%, 53.4% and 26.3% for N0, N1 and N2, respectively (P < 0.001). When survival was analysed by the number of involved nodal stations, the groups with significant differences were maintained; otherwise, they were merged, and new codes were assigned as follows for exploratory analyses: NA (N0), NB (N1a), NC (N1b, N2a (i.e., N2a1 and N2a2) and N2b1) and ND (N2b2). Five‐year survival rates were 76.1%, 60.0%, 39.1%, and 11.4% for NA, NB, NC and ND, respectively, and there were significant differences among them. This N classification was an independent prognostic factor in multivariate analyses. Conclusion Pending prospective and international validation, it is practical to merge the current N categories with the number of involved lymph node stations when evaluating the postoperative prognosis of NSCLC patients.
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Affiliation(s)
- Wei Chen
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Chenlei Zhang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Gebang Wang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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Shang X, Liu J, Li Z, Lin J, Wang H. A hypothesized TNM staging system based on the number and location of positive lymph nodes may better reflect the prognosis for patients with NSCLC. BMC Cancer 2019; 19:591. [PMID: 31208403 PMCID: PMC6580546 DOI: 10.1186/s12885-019-5797-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to evaluate the feasibility and prognostic accuracy of incorporating the number of positive lymph nodes (PLN) into the TNM staging system for non-small cell lung cancer (NSCLC) patients. Methods We screened a total of 9539 patients with resected stage IA-IIIB non-small cell cancer between 2010 and 2015 from SEER database. The chi-square test was used to compare patient baseline characteristics and the X-tile model was applied to determine cut-off values for the number of PLN (nN). The X-tile model was used to screen three different cut-off values including nN = 0, nN1–3 and nN4-. Univariate and multivariate Cox proportional hazards regression models were used to analyze the influence of different variables on overall survival (OS). Kaplan-Meier and log-rank test were used to compare survival differences. Results Based on the nN cutoffs, we conducted the univariate and multivariate Cox proportional hazards regression. The result showed that nN stage was a significant prognostic factor affecting patients' OS (all P < 0.001). We reclassified the seventh edition TNM stages of the enrolled patients with stage IA-IIIB NSCLC according to the 5-year OS rate. Hypothesized TNM substage based on the location and the number of PLN was further calculated. Then we drew survival curves for each substage, including for the current TNM stage and the hypothesized TNM stage. From the comparison of survival curves, we found that the survival curve of each substage of the hypothesized TNM classification was proportional and well distributed compared with the current TNM classification (P < 0.001). Conclusion Revised TNM staging integrating locational pN stage and numerical nN stage was a more accurate prognostic determinant in patients with NSCLC.
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Affiliation(s)
- Xiaoling Shang
- Department of Clinical Laboratory, Qilu Medical College, Shandong University, Jinan, 250117, China
| | - Jia Liu
- Department of Respiration, Qianfo Shan Hospital of Shandong, Jinan, Shandong, 250021, People's Republic of China
| | - Zhenxiang Li
- Department of Radiotherapy, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Jiamao Lin
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Haiyong Wang
- Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China.
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