The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer

Jonnalagadda, Sirisha; Smith, Cardinale B.; Mhango, Grace; Wisnivesky, Juan P.

doi:10.1378/chest.10-2885

Cited by 53 publications

(29 citation statements)

References 27 publications

(57 reference statements)

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“…Although the N descriptors in the new edition of TNM system were not changed, several studies have reported that, within the N1 category, there are several prognostic modifiers. These include the number of lymph nodes involved (solitary versus multiple) [19][20][21], the ratio of lymph nodes involved [20,21], the level of lymph nodes involved (hilar versus lobar) [7,11,12,22,23], and the pattern of lymph nodes involved (direct invasion versus separate metastases) [24,25]. Several studies have highlighted that N1 disease represents a heterogeneous group of patients with different lymph node-related factors affecting prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in resected pathological N1-stage II nonsmall cell lung cancer

et al. 2012

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Stage II nonsmall cell lung cancer (NSCLC) has been redefined in the seventh edition of tumour, node, metastasis (TNM) classification for lung cancer. Stages IIa and IIb both contain node-negative (N0) and node-positive (N1) subgroups. The aim of this study was to evaluate the prognostic factors for overall survival in patients with resected N1-stage II NSCLC.Between January 1992 and December 2010, we retrospectively reviewed the clinicopathological characteristics of 163 N1-stage II (T1a-T2bN1M0) NSCLC in patients undergoing curative resection as primary treatment.Median follow-up time was 37.2 months. The 1-, 3-and 5-yr overall survival rates were 85.3%, 62.1% and 43.5%, respectively. Tumour involvement of the hilar/interlobar nodal zone and poorly differentiated histological grade were significant predictors for worse overall survival using multivariate analysis (p50.001 and p50.015, respectively). There were trends toward worse overall survival in older patients and those with larger tumour size (p50.063 and p50.075, respectively).In resected N1-stage II NSCLC, hilar/interlobar nodal involvement and poorly differentiated histological grade were significant predictors of worse overall survival. The differences in survival between these subgroups of patients may lead to the use of different adjuvant therapies or postsurgical follow-up strategies.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors in resected pathological N1-stage II nonsmall cell lung cancer

et al. 2012

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“…Other approaches for the evaluation of LN management during lung resection include the number of resected LN, the LN ratio (LNR), the number of resected LN stations, and nodal upstaging (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry

Bertani¹,

Gonfiotti²,

Nosotti³

et al. 2017

J. Thorac. Dis.

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Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC.Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies.Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies.Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98].Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

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“…Therefore, the number of metastatic LNs may be more important than the total number of dissected LNs. Previous studies reported that the number of metastatic LNs can predict the outcome after NSCLC complete resection, and that this is a strong independent prognostic factor (15,24,25). It was suggested that this approach provides more accurate pathologic nodal staging then the method of considering the anatomical location of involved LNs (26).…”

Section: Discussionmentioning

confidence: 99%

“…Saji et al found that four or more affected LNs were a good indicator of outcome after surgery (25). Jonnalagadda et al also reported that the number of affected LNs was an independent prognostic factor for overall survival in patients with N1 NSCLC (15). However, all previous studies analyzed the data with the Cox proportional hazards model, with adjustment for other potential prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported that the number of LNs removed in early stage NSCLC patients who underwent lobectomy was an independent positive prognostic factor for overall and lung overall survival (6,12,13). Other studies suggest that the number of dissected LNs has no significant impact on overall survival, whereas the number of positive LNs does (14,15).…”

Section: Introductionmentioning

confidence: 99%

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Impact of lymph node management on resectable non-small cell lung cancer patients

et al. 2017

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Results: The average number of dissected LNs was 22.7±12.8. Tumor recurrence was found in 51.3% and overall mortality was 43.3%. The number of dissected LNs was a prognostic factor for tumor recurrence [HR 0.98, 95% confidence interval (CI): 0.96-0.99]. There was a significant difference at the cut-pointed value of 11 dissected LNs for tumor recurrence (HR 2.22, 95% CI: 1.26-3.92). Dissection less than 11 nodes and less than 5 stations indicated a poor prognostic factor for tumor recurrence: for 3-4 stations (HR 3.01, 95% CI: 1.22-7.42) and for 1-2 stations (HR 1.96, 95% CI: 1.04-3.72). The positivity of dissected LNs was also a prognostic factor for tumor recurrence and overall mortality (HR 1.01, 95% CI: 1.01-1.02 and HR 1.01, 95% CI: 1.01-1.03, respectively).Conclusions: Eleven or more LN dissection with at least 5 stations influenced recurrent-free survival.Systematic LN dissection (SLND) should be performed not only to identify the positivity of dissected LNs but also to determine an accurate tumor nodal stage. A larger cohort should be further conducted to support these findings.

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The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer

Cited by 53 publications

References 27 publications

Prognostic factors in resected pathological N1-stage II nonsmall cell lung cancer

Prognostic factors in resected pathological N1-stage II nonsmall cell lung cancer

Nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry

Impact of lymph node management on resectable non-small cell lung cancer patients

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