病理单淋巴结和多淋巴结描述子在切除非小细胞肺癌中的作用

Role of Pathologic Single-Nodal and Multiple-Nodal Descriptors in Resected Non-Small Cell Lung Cancer

CHEST

影响因子:8.6

分区:医学1区 Top / 呼吸系统1区危重病医学2区

发表日期:2024 Nov

作者: Shinkichi Takamori, Atsushi Osoegawa, Asato Hashinokuchi, Takashi Karashima, Yohei Takumi, Miyuki Abe, Masafumi Yamaguchi, Tomoyoshi Takenaka, Tomoharu Yoshizumi, Junjia Zhu, Takefumi Komiya

DOI: 10.1016/j.chest.2024.06.3797

摘要

第八版肺癌淋巴结分期包括淋巴结转移的部位，但未包括单淋巴结和多淋巴结状态。单淋巴结和多淋巴结状态是否能区分非小细胞肺癌（NSCLC）患者的预后？利用国家癌症数据库，我们分析了病理分期为N1和N2的NSCLC患者。淋巴结描述子被分类为病理单N1（pSingle-N1）、病理多N1（pMulti-N1）、病理单N2（pSingle-N2）和病理多N2（pMulti-N2）。采用Kaplan-Meier法和多变量Cox回归模型进行生存分析。在总体分析队列中，24,531例、22,256例、8,528例和21,949例NSCLC患者分别表现为pSingle-N1、pMulti-N1、pSingle-N2和pMulti-N2疾病。pMulti-N1和pMulti-N2患者的生存期短于pSingle-N1和pSingle-N2患者（风险比HR，分别为1.22 [P < .0001] 和1.39 [P < .0001]）。调整年龄、性别和组织学特征后，pSingle-N2与pMulti-N1的风险比为1.05（P = .0031）。pN1疾病患者根据转移淋巴结数（1、2、3及≥4）进行分类，显示出显著的预后差异（P < .0001）。在敏感性分析队列（仅限R0切除、肺叶切除或更大范围、存活≥30天、检查淋巴结≥10个、无新辅助治疗；n=34,904）及外部验证队列（n=708）中，分析结果支持这些结论。非小细胞肺癌伴一个转移淋巴结（无论是在N1还是N2）患者的生存优于涉及多个淋巴结者。单跳N2淋巴结转移患者的生存与多N1淋巴结患者相似，且N1切除中涉及的淋巴结数最多到四个或更多，逐步具有预后意义。

Abstract

The eighth edition of lung cancer nodal staging assignment includes the location of lymph node metastasis, but does not include single-nodal and multiple-nodal descriptors.Do the single-nodal and multiple-nodal statuses stratify the prognosis of patients with non-small cell lung cancer (NSCLC)?Using the National Cancer Database, we analyzed patients with pathologically staged N1 and N2 NSCLC. Nodal descriptors were classified into pathological single N1 (pSingle-N1), pathological multiple N1 (pMulti-N1), pathological single N2 (pSingle-N2), and pathological multiple N2 (pMulti-N2). Survival analysis was performed using the Kaplan-Meier method and multivariable Cox regression models.In the general analysis cohort, 24,531, 22,256, 8,528, and 21,949 patients with NSCLC demonstrated pSingle-N1, pMulti-N1, pSingle-N2, and pMulti-N2 disease, respectively. Patients with pMulti-N1 and pMulti-N2 disease showed a shorter survival than those with pSingle-N1 and pSingle-N2 disease, respectively (hazard ratio, 1.22 [P < .0001] for N1 and 1.39 [P < .0001] for N2). After adjusting age, sex, and histologic findings, the hazard ratio for pSingle-N2 compared with pMulti-N1 disease was 1.05 (P = .0031). Patients with pN1 disease were categorized by metastatic lymph node count (1, 2, 3, ≥ 4), showing significant prognostic differences among groups (P < .0001). In the sensitivity analysis cohort (limited to R0 resection, lobectomy, or more; survival ≥ 30 days; ≥ 10 examined lymph nodes; and without neoadjuvant therapy; n = 34,904) and the external validation cohort (n = 708), analyses supported these results.Patients with NSCLC with one metastatic lymph node, whether in N1 or N2 stations, showed better survival than those with more than one lymph node involved. Patients with NSCLC with a single-skip N2 lymph node metastasis showed survival similar to patients with multiple N1 lymph nodes, and the number of lymph nodes involved in N1 resections up to four or more was sequentially prognostic.