Prognostic analysis of node status of 1 851 non-small cell lung cancer patients on the basis of the eighth TNM staging system: A cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Shaolei , YAN Shi , MA Yuanyuan , ZHANG Shanyuan , LU Fangliang ,  YANG Yue

Department of Thoracic Surgery Ⅱ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, 100142, P.R.China;

Corresponding author：

YANG Yue, Email: zlyangyue@bjmu.edu.cn

Keywords：

Non-small lung cancer; node metastasis; N Staging; surgery; prognosis

DOI：

10.7507/1007-4848.201708032

Video：

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Objective To evaluate the prognosis of different node status on the basis of the eighth TNM classification for lung cancer. Methods We retrospectively reviewed the clinical data of 1 851 non-small cell lung cancer (NSCLC) patients who underwent radical resection between January 2005 and December 2014. There were 1 078 males and 773 females at age of 16–86 (59.7±9.7) years. Survival probability was estimated by the Kaplan-Meier method and significance was assessed by the log-rank test. Results This cohort study was consisted of 1 209 patients with N0, 305 with N1 and 337 with N2. N0 patients were divided into a N0a group and a N0b group according to whether the 13 and 14 level of lymph nodes were examined. The survival rate of the N0a group was significantly higher than that of the N0b group, and the 5-year survival rate was 88.9% and 81.3% (P<0.001), respectively. According to the number of lymph node metastasis stations, N1 was divided into a N1a (single) group and a N1b (multiple) group. And no significant difference was observed between the two groups in survival rate (P=0.562). Based on the presence of lymph nodes of 10–12 level, N1 was divided into a negative group and a positive group. And the negative group was found with significantly higher survival rate than the positive group (5-year survival rate of 78.4% vs. 64.3%, P=0.007). The N2 patients were divided into a single station metastasis group (a N2a1 group), a single station with N1 positive group (a N2a2 group) and a multiple station group (a N2b group), and the percentage was accounted for 22.0% (74/337), 37.7% (127/337) and 40.3% (136/337), respectively. There was a statistical difference in 5-year survival rate (62.2% vs. 56.5% vs. 37.3%) among the three groups (P=0.001). Conclusion Subgroup analysis of N staging in NSCLC patients shows significant survival differences which may be more consistent with multidisciplinary therapy under precise staging patterns.

Citation： LI Shaolei, YAN Shi, MA Yuanyuan, ZHANG Shanyuan, LU Fangliang, YANG Yue. Prognostic analysis of node status of 1 851 non-small cell lung cancer patients on the basis of the eighth TNM staging system: A cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 387-392. doi: 10.7507/1007-4848.201708032 Copy

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9.	Osarogiagbon RU, Ray MA, Faris NR, et al. Prognostic value of national comprehensive cancer network lung cancer resection quality criteria. Ann Thorac Surg, 2017, 103(5): 1557-1565.
10.	David EA, Cooke DT, Chen Y, et al. Does lymph node count influence survival in surgically resected non-small cell lung cancer?Ann Thorac Surg, 2017, 103(1): 226-235.
11.	Yeh YC, Kadota K, Nitadori J, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification predicts occult lymph node metastasis in clinically mediastinal node-negative lung adenocarcinoma. Eur J Cardiothorac Surg, 2016, 49(1): e9-e15.
12.	Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients. Eur J Cardiothorac Surg, 2017, 51(4): 674-679.
13.	Kanzaki R, Higashiyama M, Fujiwara A, et al. Occult mediastinal lymph node metastasis in NSCLC patients diagnosed as clinical N0-1 by preoperative integrated FDG-PET/CT and CT: Risk factors, pattern, and histopathological study. Lung Cancer, 2011, 71(3): 333-337.
14.	Xu YP, Li B, Xu XL, et al. Is there a survival benefit in patients with stage IIIA (N2) non-small cell lung cancer receiving neoadjuvant chemotherapy and/or radiotherapy prior to surgical resection: a systematic review and meta-analysis. Medicine (Baltimore), 2015, 94(23): e879.
15.	Ramnath N, Dilling TJ, Harris LJ, et al. Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e314S-e340S.
16.	Auperin A, Le Pechoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 2010, 28(13):2181-2190.
17.	Chang JY, Kestin LL, Barriger RB, et al. ACR appropriateness criteria(R) nonsurgical treatment for locally advanced non-small-cell lung cancer: good performance status/definitive intent. Oncology (Williston Park), 2014, 28(8):706-710, 712, 714.

1. She J, Yang P, Hong Q, et al. Lung cancer in China: challenges and interventions. Chest 2013, 143(4): 1117-1126.
2. Torre LA, Bray F, Siegel RL, et al. CA Cancer J Clin, 2015, 65(2):87-108.
3. Johnson DH, Schiller JH, Bunn PA, Jr. Recent clinical advances in lung cancer management. J Clin Oncol 2014, 32(10):973-982.
4. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
5. Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer lung cancer staging project: proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(12): 1675-1684.
6. Wang X, Yan S, Lv C, et al. Impact of omission of intrapulmonary lymph node retrieval on outcome evaluation of lung cancer patients without lymph node metastasis: a propensity score matching analysis. Clin Lung Cancer, 2017, 18(6): e411-e416.
7. Maeshima AM, Tsuta K, Asamura H, et al. Prognostic implication of metastasis limited to segmental (level 13) and/or subsegmental (level 14) lymph nodes in patients with surgically resected nonsmall cell lung carcinoma and pathologic N1 lymph node status. Cancer 2012, 118(18): 4512-4518.
8. Smeltzer MP, Faris N, Yu X, et al. Missed intrapulmonary lymph node metastasis and survival after resection of non-small cell lung cancer. Ann Thorac Surg, 2016, 102(2): 448-453.
9. Osarogiagbon RU, Ray MA, Faris NR, et al. Prognostic value of national comprehensive cancer network lung cancer resection quality criteria. Ann Thorac Surg, 2017, 103(5): 1557-1565.
10. David EA, Cooke DT, Chen Y, et al. Does lymph node count influence survival in surgically resected non-small cell lung cancer?Ann Thorac Surg, 2017, 103(1): 226-235.
11. Yeh YC, Kadota K, Nitadori J, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification predicts occult lymph node metastasis in clinically mediastinal node-negative lung adenocarcinoma. Eur J Cardiothorac Surg, 2016, 49(1): e9-e15.
12. Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients. Eur J Cardiothorac Surg, 2017, 51(4): 674-679.
13. Kanzaki R, Higashiyama M, Fujiwara A, et al. Occult mediastinal lymph node metastasis in NSCLC patients diagnosed as clinical N0-1 by preoperative integrated FDG-PET/CT and CT: Risk factors, pattern, and histopathological study. Lung Cancer, 2011, 71(3): 333-337.
14. Xu YP, Li B, Xu XL, et al. Is there a survival benefit in patients with stage IIIA (N2) non-small cell lung cancer receiving neoadjuvant chemotherapy and/or radiotherapy prior to surgical resection: a systematic review and meta-analysis. Medicine (Baltimore), 2015, 94(23): e879.
15. Ramnath N, Dilling TJ, Harris LJ, et al. Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e314S-e340S.
16. Auperin A, Le Pechoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 2010, 28(13):2181-2190.
17. Chang JY, Kestin LL, Barriger RB, et al. ACR appropriateness criteria(R) nonsurgical treatment for locally advanced non-small-cell lung cancer: good performance status/definitive intent. Oncology (Williston Park), 2014, 28(8):706-710, 712, 714.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognostic analysis of node status of 1 851 non-small cell lung cancer patients on the basis of the eighth TNM staging system: A cohort study

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