Number of metastatic lymph nodes and zones as prognostic factors in non-small-cell lung cancer

• Published in: Interactive cardiovascular and thoracic surgery Vol. 31; no. 3; pp. 305 - 314
• Main Authors: Maniwa, Tomohiro, Ohmura, Akiisa, Hiroshima, Takashi, Ike, Akihiro, Kimura, Toru, Nakamura, Harumi, Nakatsuka, Shin-Ichi, Okami, Jiro, Higashiyama, Masahiko
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.09.2020
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Female; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - surgery; Lymph Nodes - pathology; Lymphatic Metastasis; Male; Mediastinum; Middle Aged; Neoplasm Staging; Prognosis; Retrospective Studies; Young Adult; Lymph node dissection; Tumour-node-metastasis staging system; Lung cancer
• ISSN: 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivaa107

Abstract OBJECTIVES Characterizing pathological nodes (pNs) by location alone is sometimes inadequate as patients with pN1 or pN2 non-small-cell lung cancer (NSCLC) show prognostic heterogeneity. We aimed to assess the relationship of the number of metastatic lymph nodes (LNs) and zones with prognosis in NSCLC patients. METHODS We analysed 1393 patients who underwent lobectomy with mediastinal LN dissection for NSCLC at the Osaka International Cancer Institute between January 2006 and December 2015. Patients were classified into 3 groups according to the number of LNs: n1–3, n4–6 and n7–. We investigated the relationship of prognosis with the number of metastatic LNs and metastatic zones. RESULTS In the multivariable analyses, the number of metastatic LNs and zones were not independent factors for overall survival or recurrence-free survival in patients with pN1 disease after adjustment for age, sex, tumour histology and tumour diameter. However, n4–6 (ref. n1–3) was an independent prognostic factor for overall survival [hazard ratio (HR) 4.148, P < 0.001] in those with pN2 disease. There were no significant differences in overall survival and recurrence-free survival between pN1 (HR 0.674, P = 0.175) and pN2n1–3 disease (HR 1.056, P = 0.808). Moreover, patients with pN2 disease with a higher number of metastatic zones had a poor prognosis for recurrence-free survival [3 zones (ref. 1): HR 1.774, P = 0.051, and 4 zones (ref. 1): HR 2.173, P < 0.047]. CONCLUSIONS The number of metastatic LNs and metastatic zones were useful prognostic factors in NSCLC patients. The findings could help in establishing a new pN classification.