Combining node location and node ratio as a prognostic factor for surgical resected non-small cell lung cancer: a...

Area of Science:

• Oncology
• Thoracic Surgery
• Cancer Prognostics

Background:

• Current TNM staging for non-small cell lung cancer (NSCLC) relies solely on the anatomic location of lymph nodes.
• The ratio of metastatic lymph nodes (NR) is not incorporated into standard staging systems.

Purpose of the Study:

• To evaluate the effectiveness of combining lymph node location (pN) and the ratio of metastatic lymph nodes (pN-NR) for predicting prognosis in NSCLC.
• To determine if pN-NR offers improved prognostic value over traditional staging methods.

Main Methods:

• Retrieved data for pN1/pN2 NSCLC patients from the SEER database.
• Determined the optimal cut-point for NR using the maximal selecting test.
• Categorized patients into four groups based on pN and NR (low/high).
• Utilized Cox regression and Kaplan-Meier analysis to assess pN-NR as a predictor of overall survival (OS) and cause-specific survival (CSS).

Main Results:

• A total of 12,170 patients were analyzed; the optimal NR cut-point was 0.3.
• pN-NR independently predicted survival outcomes.
• Compared to pN1-NR <0.3, hazard ratios for OS increased significantly across other groups (pN1-NR ≥0.3, pN2-NR <0.3, pN2-NR ≥0.3).
• Five-year OS rates ranged from 47.1% (pN1-NR <0.3) to 28.5% (pN2-NR ≥0.3), with clear separation between the four pN-NR groups.
• Similar trends were observed for CSS, with consistent results across subgroups except for pneumonectomy patients.

Conclusions:

• The combined metric of lymph node location and metastatic ratio (pN-NR) serves as a robust predictor for NSCLC prognosis.
• Incorporating pN-NR into staging could enhance survival predictions for NSCLC patients.
• Further validation may refine its clinical application in NSCLC management.