Top

Lung

Published in:

01-10-2020 | NSCLC | LUNG CANCER

Negative Lymph Node Count Predicts Survival of Resected Non-small Cell Lung Cancer

Authors: Xinyan Zhou, Chunxiao Wu, Qi Cheng

Published in: Lung | Issue 5/2020

Abstract

Purpose

The purpose of this study was to explore the association between the negative lymph node (NLN) count and survival, as well as compare the prognostic value of the positive lymph node (PLN) count, lymph node ratio (the PLN count/total lymph nodes examined, LNR), and NLN count in patients with non-small cell lung cancer (NSCLC).

Methods

We identified patients diagnosed with NSCLC between 2005 and 2011 from the Surveillance, Epidemiology, and End Results database. Outcomes of interest were lung cancer-specific survival (LCSS) and overall survival (OS). Cases were divided into several groups based on the PLN count, NLN count, and LNR. The prognostic significance of the PLN count, NLN count, and LNR models was analyzed with the Kaplan–Meier method and the Cox regression model.

Results

39,959 patients with surgical resection for NSCLC were identified. Univariate analysis demonstrated that a greater count of NLNs was associated with better LCSS (P < 0.001) and OS (P < 0.001). Subgroup analysis showed that the NLN count could predict survival in both node-negative and node-positive patients. Multivariable analysis revealed that the NLN count was an independent prognostic factor for LCSS and OS.

Conclusion

The NLN count is an independent prognostic factor of OS and LCSS in patients with NSCLC, as well as the PLN count and LNR. The prognostic value of the PLN count, NLN count, and LNR shows no difference.

Siegel RL, Miller KD (2019) Jemal A (2019) Cancer statistics. CA-Cancer J Clin 69(1):7–34. https://doi.org/10.3322/caac.21551CrossRefPubMed

Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, Nicholson AG, Groome P, Mitchell A, Bolejack V, Int Assoc Study Lung Canc S (2016) 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. Journal of Thoracic Oncology 11(1):39–51. https://doi.org/10.1016/j.jtho.2015.09.009CrossRefPubMed

Yoo C, Yoon S, Lee DH, Park S-I, Kim DK, Kim Y-H, Kim HR, Choi SH, Kim WS, Choi C-M, Jang SJ, Song SY, Kim SS, Choi EK, Lee JC, Suh C, Lee J-S, Kim S-W (2015) Prognostic Significance of the Number of Metastatic pN2 Lymph Nodes in Stage IIIA-N2 Non-Small-Cell Lung Cancer After Curative Resection. Clinical Lung Cancer 16(6):E203–E212. https://doi.org/10.1016/j.cllc.2015.04.004CrossRefPubMed

Takanen S, Bangrazi C, Graziano V, Parisi A, Resuli B, Simione L, Caiazzo R, Raffetto N, Tombolini V (2014) Number of Mediastinal Lymph Nodes as a Prognostic Factor in PN2 Non Small Cell Lung Cancer: A Single Centre Experience and Review of the Literature. Asian Pac J Cancer Prev 15(18):7559–7562. https://doi.org/10.7314/apjcp.2014.15.18.7559CrossRefPubMed

Nwogu CE, Groman A, Fahey D, Yendamuri S, Dexter E, Demmy TL, Miller A, Reid M (2012) Number of Lymph Nodes and Metastatic Lymph Node Ratio Are Associated With Survival in Lung Cancer. Ann Thorac Surg 93(5):1614–1620. https://doi.org/10.1016/j.athoracsur.2012.01.065CrossRefPubMedPubMedCentral

Jonnalagadda S, Smith C, Mhango G, Wisnivesky JP (2011) The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer. Chest 140(2):433–440. https://doi.org/10.1378/chest.10-2885CrossRefPubMedPubMedCentral

Wisnivesky JP, Arciniega J, Mhango G, Mandeli J, Halm EA (2011) Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer. Thorax 66(4):287–293. https://doi.org/10.1136/thx.2010.148601CrossRefPubMed

Wang C-L, Li Y, Yue D-S, Zhang L-M, Zhang Z-F, Sun B-S (2012) Value of the Metastatic Lymph Node Ratio for Predicting the Prognosis of Non-Small-Cell Lung Cancer Patients. World J Surg 36(2):455–462. https://doi.org/10.1007/s00268-011-1360-8CrossRefPubMed

Taylor MD, LaPar DJ, Thomas CJ, Persinger M, Stelow EB, Kozower BD, Lau CL, Jones DR (2013) Lymph Node Ratio Predicts Recurrence and Survival After R0 Resection for Non-Small Cell Lung Cancer. Ann Thorac Surg 96(4):1163–1170. https://doi.org/10.1016/j.athoracsur.2013.04.031CrossRefPubMed

10.

Tamura M, Matsumoto I, Saito D, Yoshida S, Takata M, Takemura H (2016) Lymph node ratio as a prognostic factor in patients with pathological N2 non-small cell lung cancer. World Journal of Surgical Oncology. https://doi.org/10.1186/s12957-016-1048-5CrossRefPubMedPubMedCentral

11.

Sun G, Xue L, Wang M, Zhao X (2015) Lymph node ratio is a prognostic factor for non-small cell lung cancer. Oncotarget 6(32):33912–33918. https://doi.org/10.18632/oncotarget.5669CrossRefPubMedPubMedCentral

12.

Jonnalagadda S, Arcinega J, Smith C, Wisnivesky JP (2011) Validation of the Lymph Node Ratio as a Prognostic Factor in Patients With N1 Nonsmall Cell Lung Cancer. Cancer 117(20):4724–4731. https://doi.org/10.1002/cncr.26093CrossRefPubMedPubMedCentral

13.

Wu SG, Sun JY, Zhou J, Li FY, Lin Q, Lin HX, Guan XX, He ZY (2015) Number of negative lymph nodes is associated with disease-free survival in patients with breast cancer. BMC Cancer 15:7. https://doi.org/10.1186/s12885-015-1061-zCrossRef

14.

Zhu ZF, Chen HQ, Yu WW, Fu XL, Xiang JQ, Li HC, Zhang YW, Sun MH, Wei Q, Zhao WX, Zhao KL (2014) Number of Negative Lymph Nodes is Associated with Survival in Thoracic Esophageal Squamous Cell Carcinoma Patients Undergoing Three-Field Lymphadenectomy. Ann Surg Oncol 21(9):2857–2863. https://doi.org/10.1245/s10434-014-3665-yCrossRefPubMed

15.

Wu SG, Wang Y, Zhou J, Sun JY, Li FY, Lin HX, He ZY (2015) Number of negative lymph nodes should be considered for incorporation into staging for breast cancer. Am J Cancer Res 5(2):844–853PubMedPubMedCentral

16.

Wu SG, Peng F, Zhou J, Sun JY, Li FY, Lin Q, Lin HX, Bao Y, He ZY (2015) Number of Negative Lymph Nodes Can Predict Survival after Postmastectomy Radiotherapy According to Different Breast Cancer Subtypes. J Cancer 6(3):261–269. https://doi.org/10.7150/jca.10402CrossRefPubMedPubMedCentral

17.

Lin JY, Bai DS, Zhou BH, Chen P, Qian JJ, Jin SJ, Jiang GQ (2018) Positive relationship between number of negative lymph nodes and duration of gallbladder cancer cause-specific survival after surgery. Cancer Manag Res 10:6961–6969. https://doi.org/10.2147/cmar.S187857CrossRefPubMedPubMedCentral

18.

Kuru B (2006) Prognostic significance of total number of nodes removed, negative nodes removed, and ratio of positive nodes to removed nodes in node positive breast carcinoma. Ejso 32(10):1082–1088. https://doi.org/10.1016/j.ejso.2006.06.005CrossRefPubMed

19.

Wang SG, Zhang B, Li CG, Cui C, Yue DS, Shi BW, Zhang Q, Zhang ZF, Zhang X, Wang CL (2017) Prognostic value of number of negative lymph node in patients with stage II and IIIa non-small cell lung cancer. Oncotarget 8(45):79387–79396. https://doi.org/10.18632/oncotarget.18154CrossRefPubMedPubMedCentral

20.

National Cancer Institute. Surveillance Epidemiology and End Results. Overview of the SEER program. https://seer.cancer.gov/.

21.

Camp RL, Dolled-Filhart M, Rimm DL (2004) X-tile: A new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res 10(21):7252–7259. https://doi.org/10.1158/1078-0432.Ccr-04-0713CrossRefPubMed

22.

Roberts TJ, Colevas AD, Hara W, Holsinger FC, Oakley-Girvan I, Divi V (2016) Number of positive nodes is superior to the lymph node ratio and American Joint Committee on Cancer N staging for the prognosis of surgically treated head and neck squamous cell carcinomas. Cancer 122(9):1388–1397. https://doi.org/10.1002/cncr.29932CrossRefPubMed

23.

Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA (1982) Evaluating the yield of medical tests. JAMA 247(18):2543–2546. https://doi.org/10.1001/jama.247.18.2543CrossRefPubMed

24.

Lv P, Chen G, Zhang P (2014) Log odds of positive lymph nodes are superior to other measures for evaluating the prognosis of non-small cell lung cancer. Thoracic Cancer 5(6):570–575. https://doi.org/10.1111/1759-7714.12145CrossRefPubMedPubMedCentral

25.

Liang W, He J, Shen Y, Shen J, He Q, Zhang J, Jiang G, Wang Q, Liu L, Gao S, Liu D, Wang Z, Zhu Z, Ng CSH, Liu C-c, Petersen RH, Rocco G, D'Amico T, Brunelli A, Chen H, Zhi X, Liu B, Yang Y, Chen W, Zhou Q, He J (2017) Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non-Small-Cell Lung Cancer: A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry. J Clin Oncol 35(11):1162–1170. https://doi.org/10.1200/jco.2016.67.5140CrossRefPubMed

26.

Dziedzic D, Piotr R, Langfort R, Orlowski T, Polish Lung Cancer Study G (2017) Log odds of positive lymph nodes as a novel prognostic indicator in NSCLC staging. Surgical Oncology-Oxford 26(1):80–85. https://doi.org/10.1016/j.suronc.2017.01.004CrossRef

27.

Deng W, Xu T, Wang Y, Xu Y, Yang P, Gomez D, Liao Z (2018) Log odds of positive lymph nodes may predict survival benefit in patients with node-positive non-small cell lung cancer. Lung Cancer 122:60–66. https://doi.org/10.1016/j.lungcan.2018.05.016CrossRefPubMed

28.

Johnson PM, Porter GA, Ricciardi R, Baxter NN (2006) Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol 24(22):3570–3575. https://doi.org/10.1200/jco.2006.06.8866CrossRefPubMed

29.

Abd-Elhay FA, Elhusseiny KM, Kamel MG, Low SK, Sang TK, Mehyar GM, Minh LN, Hashan MR, Huy NT (2018) Negative Lymph Node Count and Lymph Node Ratio Are Associated With Survival in Male Breast Cancer. Clin Breast Cancer 18(6):E1293–E1310. https://doi.org/10.1016/j.clbc.2018.07.003CrossRefPubMed

30.

Schaapveld M, de Vries EGE, van der Graaf WTA, Otter R, de Vries J, Willemse PHB (2006) The prognostic effect of the number of histologically examined axillary lymph nodes in breast cancer: Stage migration or age association? Ann Surg Oncol 13(4):465–474. https://doi.org/10.1245/aso.2006.02.020CrossRefPubMed

31.

Karlsson P, Cole BF, Price KN, Coates AS, Castiglione-Gertsch M, Gusterson BA, Murray E, Linditner J, Collins JP, Holmberg SB, Fey MF, Thuerliumann B, Crivellari D, Forbes JF, Gelber RD, Goldhirsch A, Wallgren A (2007) The role of the number of uninvolved lymph nodes in predicting locoregional recurrence in breast cancer. J Clin Oncol 25(15):2019–2026. https://doi.org/10.1200/jco.2006.09.8152CrossRefPubMed

32.

Scosyrev E, Messing J, Noyes K, Veazie P, Messing E (2012) Surveillance Epidemiology and End Results (SEER) program and population-based research in urologic oncology: An overview. Urol Oncol-Semin Orig Investig 30(2):126–132. https://doi.org/10.1016/j.urolonc.2009.11.005CrossRef

Title: Negative Lymph Node Count Predicts Survival of Resected Non-small Cell Lung Cancer
Authors: Xinyan Zhou
Chunxiao Wu
Qi Cheng
Publication date: 01-10-2020
Publisher: Springer US
Keywords: NSCLC
Lung Cancer
Lung Cancer
NSCLC
Lung Cancer
Published in: Lung / Issue 5/2020
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI: https://doi.org/10.1007/s00408-020-00378-7

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Negative Lymph Node Count Predicts Survival of Resected Non-small Cell Lung Cancer

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2020

Don’t Drive Blind: Driving Pressure to Optimize Ventilator Management in ECMO

Connective Tissue Disease-Related Interstitial Lung Disease: Prevalence, Patterns, Predictors, Prognosis, and Treatment

Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease

Moderate or Severe Impairment in Pulmonary Function is Associated with Mortality in Sarcoidosis Patients Infected with SARS‑CoV‑2

Mepolizumab and Benralizumab in Severe Eosinophilic Asthma: Preliminary Results of a Proteomic Study

Comparison of Clinical Measures Among Interstitial Lung Disease (ILD) Patients with Usual Interstitial Pneumonia (UIP) Patterns on High-Resolution Computed Tomography

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page