{"title":"非小细胞肺癌N2a和N2b亚组跳跃转移对预后的影响:来自大型队列的见解","authors":"Shenhua Liang, Yitao Yang, Jiayuan Tian, Xingyu Luo, Zhesheng Wen, Guowei Ma","doi":"10.21037/tlcr-2025-272","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The prognostic significance of skip metastasis remains controversial in the context of the recently revised N2a (single-station) and N2b (multi-station) of non-small cell lung cancer (NSCLC). This study aims to investigate the survival impact of skip metastasis in these subgroups.</p><p><strong>Methods: </strong>We retrospectively analyzed 1,873 NSCLC patients who underwent surgery with systematic lymph node dissection at a single institution. Patients were categorized into pN1, skip pN2a, non-skip pN2a, skip pN2b, and non-skip pN2b groups. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier analysis and Cox proportional hazards regression, with propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) applied to minimize confounding.</p><p><strong>Results: </strong>Skip metastasis was identified in 34.1% of pN2 cases, with a higher incidence in pN2a (41.3%) than in pN2b (24.3%). Skip pN2a showed significantly better 5-year OS and DFS rates compared to non-skip pN2a (72% <i>vs.</i> 67%, P=0.02; 57% <i>vs.</i> 48%, P=0.002). Similarly, skip pN2b had superior outcomes compared to non-skip pN2b (5-year OS: 65% <i>vs.</i> 58%, P=0.008; DFS: 42% <i>vs.</i> 37%, P=0.03). Notably, no significant survival difference was observed between skip pN2a and pN1, or between non-skip pN2a and skip pN2b, even after PSM and IPTW adjustments.</p><p><strong>Conclusions: </strong>Skip metastasis confers a survival advantage in both pN2a and pN2b NSCLC subgroups with comparable survival between skip pN2a and pN1, as well as between non-skip pN2a and skip pN2b.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":"14 7","pages":"2537-2559"},"PeriodicalIF":3.5000,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337039/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prognostic impacts of skip metastasis in N2a and N2b subgroups of non-small cell lung cancer: insights from a large cohort.\",\"authors\":\"Shenhua Liang, Yitao Yang, Jiayuan Tian, Xingyu Luo, Zhesheng Wen, Guowei Ma\",\"doi\":\"10.21037/tlcr-2025-272\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The prognostic significance of skip metastasis remains controversial in the context of the recently revised N2a (single-station) and N2b (multi-station) of non-small cell lung cancer (NSCLC). This study aims to investigate the survival impact of skip metastasis in these subgroups.</p><p><strong>Methods: </strong>We retrospectively analyzed 1,873 NSCLC patients who underwent surgery with systematic lymph node dissection at a single institution. Patients were categorized into pN1, skip pN2a, non-skip pN2a, skip pN2b, and non-skip pN2b groups. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier analysis and Cox proportional hazards regression, with propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) applied to minimize confounding.</p><p><strong>Results: </strong>Skip metastasis was identified in 34.1% of pN2 cases, with a higher incidence in pN2a (41.3%) than in pN2b (24.3%). Skip pN2a showed significantly better 5-year OS and DFS rates compared to non-skip pN2a (72% <i>vs.</i> 67%, P=0.02; 57% <i>vs.</i> 48%, P=0.002). Similarly, skip pN2b had superior outcomes compared to non-skip pN2b (5-year OS: 65% <i>vs.</i> 58%, P=0.008; DFS: 42% <i>vs.</i> 37%, P=0.03). Notably, no significant survival difference was observed between skip pN2a and pN1, or between non-skip pN2a and skip pN2b, even after PSM and IPTW adjustments.</p><p><strong>Conclusions: </strong>Skip metastasis confers a survival advantage in both pN2a and pN2b NSCLC subgroups with comparable survival between skip pN2a and pN1, as well as between non-skip pN2a and skip pN2b.</p>\",\"PeriodicalId\":23271,\"journal\":{\"name\":\"Translational lung cancer research\",\"volume\":\"14 7\",\"pages\":\"2537-2559\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2025-07-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337039/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Translational lung cancer research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/tlcr-2025-272\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational lung cancer research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tlcr-2025-272","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/28 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:跳跃转移的预后意义在最近修订的非小细胞肺癌(NSCLC)的N2a(单站)和N2b(多站)的背景下仍然存在争议。本研究旨在探讨跳跃式转移对这些亚群存活的影响。方法:我们回顾性分析了1873例在同一医院接受系统性淋巴结清扫手术的非小细胞肺癌患者。患者分为pN1组、跳过pN2a组、非跳过pN2a组、跳过pN2b组和非跳过pN2b组。使用Kaplan-Meier分析和Cox比例风险回归评估总生存期(OS)和无病生存期(DFS),并使用倾向评分匹配(PSM)和治疗加权逆概率(IPTW)来最小化混淆。结果:34.1%的pN2患者存在跳跃性转移,其中pN2a患者(41.3%)高于pN2b患者(24.3%)。与非跳过pN2a相比,跳过pN2a的5年OS和DFS率显著提高(72% vs. 67%, P=0.02;57% vs. 48%, P=0.002)。同样,跳过pN2b的结果优于非跳过pN2b(5年OS: 65% vs. 58%, P=0.008;DFS: 42% vs. 37%, P=0.03)。值得注意的是,即使经过PSM和IPTW调整,跳过pN2a和pN1之间,或非跳过pN2a和跳过pN2b之间的存活率也没有显著差异。结论:跳跃性转移在pN2a和pN2b NSCLC亚组中均具有生存优势,跳跃性pN2a和pN1之间以及非跳跃性pN2a和跳跃性pN2b之间的生存率相当。
Prognostic impacts of skip metastasis in N2a and N2b subgroups of non-small cell lung cancer: insights from a large cohort.
Background: The prognostic significance of skip metastasis remains controversial in the context of the recently revised N2a (single-station) and N2b (multi-station) of non-small cell lung cancer (NSCLC). This study aims to investigate the survival impact of skip metastasis in these subgroups.
Methods: We retrospectively analyzed 1,873 NSCLC patients who underwent surgery with systematic lymph node dissection at a single institution. Patients were categorized into pN1, skip pN2a, non-skip pN2a, skip pN2b, and non-skip pN2b groups. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier analysis and Cox proportional hazards regression, with propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) applied to minimize confounding.
Results: Skip metastasis was identified in 34.1% of pN2 cases, with a higher incidence in pN2a (41.3%) than in pN2b (24.3%). Skip pN2a showed significantly better 5-year OS and DFS rates compared to non-skip pN2a (72% vs. 67%, P=0.02; 57% vs. 48%, P=0.002). Similarly, skip pN2b had superior outcomes compared to non-skip pN2b (5-year OS: 65% vs. 58%, P=0.008; DFS: 42% vs. 37%, P=0.03). Notably, no significant survival difference was observed between skip pN2a and pN1, or between non-skip pN2a and skip pN2b, even after PSM and IPTW adjustments.
Conclusions: Skip metastasis confers a survival advantage in both pN2a and pN2b NSCLC subgroups with comparable survival between skip pN2a and pN1, as well as between non-skip pN2a and skip pN2b.
期刊介绍:
Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.