病理单节和多节点描述源在切除的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
影响因子:8.60000
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
摘要
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.将淋巴结描述符分为病理性的单个N1（PSINGLE-N1），病理多重N1（PMULTI-N1），病理单n2（Psingle-N2）和病理多重N2（PMULTI-N2）。使用Kaplan-Meier方法和多变量COX回归模型进行生存分析。在一般分析队列中，24,531、22,256、8,528和21,949例NSCLC患者分别证明了Psingle-N1，Pmingle-N1，Psingle-N1，Psingle-N2和Pmulti-N2疾病。 PMULTI-N1和PMULTI-N2疾病的患者的存活率比psingle-N1和Psingle-N2疾病的患者较短（N1的危险比为1.22 [P <.0001]和N2的1.39 [P <.0001]）。调整年龄，性别和组织学发现后，与PMULTI-N1疾病相比，Psingle-N2的危险比为1.05（p = .0031）。通过转移性淋巴结计数（1、2、3，≥4）对患有PN1疾病的患者进行分类，显示组之间的预后差异很大（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比涉及多个淋巴结的人的生存期更好。 NSCLC患有单个SKIP N2淋巴结转移的患者的存活率与多个N1淋巴结的患者相似，而参与N1切除术的淋巴结的数量最多是四个或更多的预后。
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.