A hypothesized TNM staging system based on the number and location of positive lymph nodes may better reflect the prognosis for patients with NSCLC

• Published in: BMC cancer Vol. 19; no. 1; p. 591
• Main Authors: Shang, Xiaoling, Liu, Jia, Li, Zhenxiang, Lin, Jiamao, Wang, Haiyong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.06.2019; BioMed Central; BMC
• Subjects: Aged; Bladder cancer; Cancer; Cancer patients; Cancer research; Cancer staging; Cancer therapies; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Chi-Square Distribution; Classification; Data Accuracy; Female; Follow-Up Studies; Health aspects; Humans; Kaplan-Meier Estimate; Lung cancer; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lymph nodes; Lymph Nodes - pathology; Lymphatic Metastasis - pathology; Lymphatic system; Male; Medical prognosis; Medical research; Metastasis; Middle Aged; Multivariate Analysis; Neoplasm Staging - methods; Non-small cell lung cancer; Non-small cell lung carcinoma; Patients; Prognosis; Proportional Hazards Models; Radiation therapy; Regression analysis; Retrospective Studies; SEER Program; Small cell lung cancer; Software; Surgery; Surveillance; Survival Rate; Tumors; United States > US
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-019-5797-8

This study aimed to evaluate the feasibility and prognostic accuracy of incorporating the number of positive lymph nodes (PLN) into the TNM staging system for non-small cell lung cancer (NSCLC) patients. We screened a total of 9539 patients with resected stage IA-IIIB non-small cell cancer between 2010 and 2015 from SEER database. The chi-square test was used to compare patient baseline characteristics and the X-tile model was applied to determine cut-off values for the number of PLN (nN). The X-tile model was used to screen three different cut-off values including nN = 0, nN1-3 and nN4-. Univariate and multivariate Cox proportional hazards regression models were used to analyze the influence of different variables on overall survival (OS). Kaplan-Meier and log-rank test were used to compare survival differences. Based on the nN cutoffs, we conducted the univariate and multivariate Cox proportional hazards regression. The result showed that nN stage was a significant prognostic factor affecting patients' OS (all P <  0.001). We reclassified the seventh edition TNM stages of the enrolled patients with stage IA-IIIB NSCLC according to the 5-year OS rate. Hypothesized TNM substage based on the location and the number of PLN was further calculated. Then we drew survival curves for each substage, including for the current TNM stage and the hypothesized TNM stage. From the comparison of survival curves, we found that the survival curve of each substage of the hypothesized TNM classification was proportional and well distributed compared with the current TNM classification (P <  0.001). Revised TNM staging integrating locational pN stage and numerical nN stage was a more accurate prognostic determinant in patients with NSCLC.