Comparative evaluation of negative lymph node count, positive lymph node count, and lymph node ratio in prognostication of survival following completely resection for non-small cell lung cancer: a multicenter population-based analysis.
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Abstract
Objective: Lung cancer is the leading cause of cancer-related mortality. Lymph node involvement remains a crucial prognostic factor in non-small cell lung cancer (NSCLC), and the TNM system is the current standard for staging. However, it mainly considers the anatomical location of lymph nodes, neglecting the significance of node count. Metrics like metastatic lymph node count and lymph node ratio (LNR) have been proposed as more accurate predictors.
Methods: We used data from the SEER 17 Registry Database (2010-2019), including 52,790 NSCLC patients who underwent lobectomy or pneumonectomy, with at least one lymph node examined. Primary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression models assessed the prognostic value of negative lymph node (NLN) count, number of positive lymph node (NPLN), and LNR, with cut-points determined using X-tile software. Model performance was evaluated by the Akaike information criterion (AIC).
Results: The Cox proportional hazards model analysis revealed that NLN, NPLN, and LNR are independent prognostic factors for OS and LCSS (P < 0.0001). Higher NLN counts were associated with better survival (HR = 0.79, 95% CI = 0.76-0.83, P < 0.0001), while higher NPLN (HR = 2.19, 95% CI = 1.79-2.67, P < 0.0001) and LNR (HR = 1.64, 95% CI = 1.79-2.67, P < 0.0001) values indicated worse outcomes. Kaplan-Meier curves for all three groups (NLN, NPLN, LNR) demonstrated clear stratification (P < 0.0001). The NLN-based model (60,066.5502) exhibited the strongest predictive performance, followed by the NPLN (60,508.8957) and LNR models (60,349.4583), although the differences in AIC were minimal.
Conclusions: NLN count, NPLN, and LNR were all identified as independent prognostic indicators in patients with NSCLC. Among these, the predictive model based on NLN demonstrated a marginally superior prognostic value compared to NPLN, with NPLN outperforming the LNR model. Notably, higher NLN counts, along with lower NPLN and LNR values, were consistently associated with improved survival outcomes. The relationship between these prognostic markers and NSCLC survival warrants further validation through prospective studies.
目的：肺癌是癌症相关死亡的主要原因。淋巴结受累仍然是非小细胞肺癌（NSCLC）的关键预后因素，TNM系统是目前的分期标准。但主要考虑淋巴结的解剖位置，忽略了淋巴结计数的意义。转移性淋巴结计数和淋巴结比率（LNR）等指标被认为是更准确的预测指标。方法：我们使用来自SEER 17注册数据库（2010-2019）的数据，包括52,790例接受肺叶切除术或全肺切除术且至少检查了一个淋巴结的非小细胞肺癌患者。主要结局是总生存期（OS）和癌症特异性生存期（CSS）。Cox回归模型评估阴性淋巴结（NLN）计数、阳性淋巴结（NPLN）数量和LNR的预后价值，并使用X-tile软件确定切点。采用赤池信息准则（Akaike information criterion， AIC）评价模型的性能。结果：Cox比例风险模型分析显示，NLN、NPLN和LNR是OS和LCSS的独立预后因素（P P P P P P）。结论：NLN计数、NPLN和LNR均被确定为非小细胞肺癌患者的独立预后指标。其中，基于NLN的预测模型的预后价值略优于NPLN，其中NPLN优于LNR模型。值得注意的是，较高的NLN计数，以及较低的NPLN和LNR值，始终与改善的生存结果相关。这些预后指标与NSCLC生存之间的关系有待通过前瞻性研究进一步验证。
期刊介绍：
Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles.
Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery.
Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact.
The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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