Effect of positive lymph node ratio on prognosis of patients with non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PANGYao ^1,2 ,  ZHUZijiang ¹ , YUANJibao ² , WANGWenhao ²

1. Department of Thoracic Surgery 2, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;
2. School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China;

Corresponding author：

ZHUZijiang, Email: zhuzijiang2005@sina.com

Keywords：

Positive lymph nodes ratio; non-small cell lung cancer; prognosis

DOI：

10.7507/1007-4848.201603061

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objctive To explore the effect of positive lymph nodes ratio (LNR) on prognosis of patients with non-small cell lung cancer (NSCLC). Methods Clinical data of 432 NSCLC patients undergoing radical surgery for lung cancer and systemic lymph node dissection in our hospital from January 2010-2013 were retrospectively analyzed. There were 316 males and 116 females with age of 39-84 (57.59±9.16) years. Among 432 patients, 229 (53.0%) were classified as N0 based on pathological staging of lymph nodes, 104 (24.1%) as N1 and 99 (22.9%) as N2. Kaplan-Meier curve and COX multi-factor regression model were used to evaluate the correlation between the clinical data and patients' survival. Results Five lymph nodes on average (range, 1-52) were removed in each patient. Kaplan-Meier survival curves showed that the higher the staging of positive lymph nodes was, the shorter the patients' overall survival and disease-free survival were (P<0.001). Survival analysis showed that the LNR was closely associated with disease-free survival and overall survival (P<0.001). COX multivariate analysis revealed that the LNR staging was an independent risk factor of prognosis of NSCLC. Conclusion LNR is an independent prognostic factor of NSCLC, and can be used to improve lymph node staging in standards for NSCLC staging in the future.

Citation： PANGYao, ZHUZijiang, YUANJibao, WANGWenhao. Effect of positive lymph node ratio on prognosis of patients with non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(2): 132-137. doi: 10.7507/1007-4848.201603061 Copy

1.	Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol, 2005, 23(34): 8706-8712.
2.	Partelli S, Fernandez-Del Castillo C, Bassi C, et al. Invasive intraductal papillary mucinous carcinomas of the pancreas: predictors of survival and the role of lymph node ratio. Ann Surg, 2010, 251(3): 477-482. .
3.	Vinh-Hung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol, 2009, 27(7): 1062-1068.
4.	Kunisaki C, Makino H, Akiyama H, et al. Clinical significance of the metastatic lymphnode ratio in early gastric cancer. J Gastrointest Surg, 2008, 12(3): 542-549.
5.	Sobin LH GM, Wittekind C. TNM classification of malignant tumours. 7th ed. New York: Wiley. 2009.
6.	Wei S, Asamura H, Kawachi R, et al. Which is the better prognostic factor for resected non-small cell lung cancer: the number of metastatic lymph nodes or the currently used nodal stage classification? J Thorac Oncol, 2011, 6(2): 310-318.
7.	Wisnivesky JP, Arciniega J, Mhango G, et al. Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer. Thorax, 2011, 66(4): 287-293.
8.	Matsuguma H, Oki I, Nakahara R, et al. Proposal of new nodal classifications for non-small cell lung cancer based on the number and ratio of metastatic lymph nodes. Eur J Cardiothorac Surg, 2012, 41(1): 19-24.
9.	Wang CL, Li Y, Yue DS, et al. Value ofthe metastatic lymph node ratio for predicting the prognosis of non-small cell lung cancer patients. World J Surg, 2012, 36(2): 455-462.
10.	Fukui T, Mori S, Yokoi K, et al. Significance of the number of positive lymph nodes in resected non-small cell lung cancer. J Thorac Oncol, 2006, 1(2): 120-125.
11.	Lee JG, Lee CY, Park IK, et al. Number of metastatic lymph nodes in resected non-small cell lung cancer predicts patient survival. Ann Thorac Surg, 2008, 85(1): 211-215.
12.	Lee CW, Wilkinson KH, Sheka AC, et al. The log odds of positive lymph nodes stratifies and predicts survival of high-risk individuals among stage Ⅲ rectal cancer patients. Oncologist, 2016, 21(4): 425-432.
13.	Riediger H, Keck L, Wellner U, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg, 2009, 13(7): 1337-1344.
14.	Inoue K, Nakane Y, liyama H, et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol, 2002, 9(1): 27-34.
15.	Nwogu CE, Groman A, Fahey D, et al. Number of lymph nodes and metastatic lymph node ratio are associated with survival in lung cancer. Ann Thorac Surg, 2012, 93(5): 1614-1619.
16.	Bria E, Milella M, Sperduti I, et al. A novel clinical prognostic score incorporating the number of resected lymph nodes to predict recurrence and survival in non-small cell lung cancer. Lung Cancer, 2009, 66(3): 365-371.
17.	Lee SH, Jo EJ, Eom JS, et al. Predictors of recurrence after curative resection in patients with early-stage non-small cell lung cancer. Tuberc Respir Dis (Seoul), 2015, 78(4): 341-348.
18.	Kelsey CR, Marks LB, Hollis D, et al. Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients. Cancer, 2009, 115(22): 5218-5227.
19.	Varlotto JM, Recht A, Flickinger JC, et al. Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer. Cancer, 2009, 115(5): 1059-1069.
20.	Jonnalagadda S, Arcinega J, Smith C, et al. Validation of the lymph node ratio as a prognostic factor in patients with N1 non-small cell lung cancer. Cancer, 2011, 117(20): 4724-4731.

1. Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol, 2005, 23(34): 8706-8712.
2. Partelli S, Fernandez-Del Castillo C, Bassi C, et al. Invasive intraductal papillary mucinous carcinomas of the pancreas: predictors of survival and the role of lymph node ratio. Ann Surg, 2010, 251(3): 477-482. .
3. Vinh-Hung V, Verkooijen HM, Fioretta G, et al. Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol, 2009, 27(7): 1062-1068.
4. Kunisaki C, Makino H, Akiyama H, et al. Clinical significance of the metastatic lymphnode ratio in early gastric cancer. J Gastrointest Surg, 2008, 12(3): 542-549.
5. Sobin LH GM, Wittekind C. TNM classification of malignant tumours. 7th ed. New York: Wiley. 2009.
6. Wei S, Asamura H, Kawachi R, et al. Which is the better prognostic factor for resected non-small cell lung cancer: the number of metastatic lymph nodes or the currently used nodal stage classification? J Thorac Oncol, 2011, 6(2): 310-318.
7. Wisnivesky JP, Arciniega J, Mhango G, et al. Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer. Thorax, 2011, 66(4): 287-293.
8. Matsuguma H, Oki I, Nakahara R, et al. Proposal of new nodal classifications for non-small cell lung cancer based on the number and ratio of metastatic lymph nodes. Eur J Cardiothorac Surg, 2012, 41(1): 19-24.
9. Wang CL, Li Y, Yue DS, et al. Value ofthe metastatic lymph node ratio for predicting the prognosis of non-small cell lung cancer patients. World J Surg, 2012, 36(2): 455-462.
10. Fukui T, Mori S, Yokoi K, et al. Significance of the number of positive lymph nodes in resected non-small cell lung cancer. J Thorac Oncol, 2006, 1(2): 120-125.
11. Lee JG, Lee CY, Park IK, et al. Number of metastatic lymph nodes in resected non-small cell lung cancer predicts patient survival. Ann Thorac Surg, 2008, 85(1): 211-215.
12. Lee CW, Wilkinson KH, Sheka AC, et al. The log odds of positive lymph nodes stratifies and predicts survival of high-risk individuals among stage Ⅲ rectal cancer patients. Oncologist, 2016, 21(4): 425-432.
13. Riediger H, Keck L, Wellner U, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg, 2009, 13(7): 1337-1344.
14. Inoue K, Nakane Y, liyama H, et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol, 2002, 9(1): 27-34.
15. Nwogu CE, Groman A, Fahey D, et al. Number of lymph nodes and metastatic lymph node ratio are associated with survival in lung cancer. Ann Thorac Surg, 2012, 93(5): 1614-1619.
16. Bria E, Milella M, Sperduti I, et al. A novel clinical prognostic score incorporating the number of resected lymph nodes to predict recurrence and survival in non-small cell lung cancer. Lung Cancer, 2009, 66(3): 365-371.
17. Lee SH, Jo EJ, Eom JS, et al. Predictors of recurrence after curative resection in patients with early-stage non-small cell lung cancer. Tuberc Respir Dis (Seoul), 2015, 78(4): 341-348.
18. Kelsey CR, Marks LB, Hollis D, et al. Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients. Cancer, 2009, 115(22): 5218-5227.
19. Varlotto JM, Recht A, Flickinger JC, et al. Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer. Cancer, 2009, 115(5): 1059-1069.
20. Jonnalagadda S, Arcinega J, Smith C, et al. Validation of the lymph node ratio as a prognostic factor in patients with N1 non-small cell lung cancer. Cancer, 2011, 117(20): 4724-4731.

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