The number of resected lymph nodes is associated with the long-term survival outcome in patients with T2 N0 non-small cell lung cancer
Received 1 September 2018
Accepted for publication 12 November 2018
Published 12 December 2018 Volume 2018:10 Pages 6869—6877
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Antonella D'Anneo
Ying-Sheng Wen,1,2,* Ke-Xing Xi,3,* Ke-Xiang Xi,4 Ru-Si Zhang,1,2 Gong-Ming Wang,1,2 Zi-Rui Huang,1,2 Lan-Jun Zhang1,5
1State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, People’s Republic of China; 2Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, People’s Republic of China; 3Department of Thoracic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou 510630, People’s Republic of China; 4Department of Obstetrics, Jieyang People’s Hospital (Jieyang Affiliated Hospital, Sun Yat-sen University), Jieyang 522000, People’s Republic of China; 5Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong, People’s Republic of China
*These authors have contributed equally to this work
Objective: For the patients with pathologic T2 N0 non-small cell lung cancer (NSCLC), the extent of lymph node (LN) removal required for survival is controversial. We aimed to explore the prognostic significance of examined LNs and to identify how many nodes should be examined.
Methods: We reviewed 549 patients who underwent pulmonary or pneumonectomy surgery or plus lymphadenectomy who were confirmed as T2 stage and LN negative by postoperative pathological diagnosis. According to Martingale residuals of the Cox model, the patients were classified into four groups by the number of examined LNs (1–2 LNs, 3–7 LNs, 8–11 LNs, and ≥12 LNs). Kaplan–Meier analysis and Cox regression analysis were used to evaluate the association between survival and the number of examined LNs.
Result: Compared with the 1–2 LNs, 3–7 LNs, and 8–11 LNs groups, the survival was significantly better in the ≥12 LNs group. The 5-year cancer-specific survival rate was 60.5% for patients with 1–2 negative LNs, compared with 68.7%, 72.6%, and 78.4% for those with 3–7, 8–11, and >11 LNs examined, respectively. The 7-year cancer-specific survival rate was 52.9% for patients with 1–2 negative LNs, compared with 63.7%, 63.8%, and 70.8% for those with 3–7, 8–11, and >11 LNs examined, respectively (P=0.045). There was a significant drop in mortality risk with the examination of more LNs. The lowest mortality risk occurred in those with 32 or more LNs examined. Multivariate analysis showed that age and the number of examined LNs were strong independent predictors of survival.
Conclusion: The number of examined LNs is a strong independent prognostic factor. Our study demonstrates that patients with T2 N0 NSCLC should have at least 12 LNs examined and that the results of this study may provide information for the optimal number of resected LNs in surgery.
Keywords: number of resected lymph nodes, non-small cell lung cancer, survival outcome
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