TY - JOUR
T1 - Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non-Small-Cell Lung Cancer
T2 - A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry
AU - Liang, Wenhua
AU - He, Jiaxi
AU - Shen, Yaxing
AU - Shen, Jianfei
AU - He, Qihua
AU - Zhang, Jianrong
AU - Jiang, Gening
AU - Wang, Qun
AU - Liu, Lunxu
AU - Gao, Shugeng
AU - Liu, Deruo
AU - Wang, Zheng
AU - Zhu, Zhihua
AU - Ng, Calvin S H
AU - Liu, Chia-Chuan
AU - Horsleben Petersen, René
AU - Rocco, Gaetano
AU - D'Amico, Thomas
AU - Brunelli, Alessandro
AU - Chen, Haiquan
AU - Zhi, Xiuyi
AU - Liu, Bo
AU - Yang, Yixin
AU - Chen, Wensen
AU - Zhou, Qian
AU - He, Jianxing
PY - 2017/4/10
Y1 - 2017/4/10
N2 - Purpose We investigated the correlation between the number of examined lymph nodes (ELNs) and correct staging and long-term survival in non-small-cell lung cancer (NSCLC) by using large databases and determined the minimal threshold for the ELN count. Methods Data from a Chinese multi-institutional registry and the US SEER database on stage I to IIIA resected NSCLC (2001 to 2008) were analyzed for the relationship between the ELN count and stage migration and overall survival (OS) by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. The selected cut point was validated with the SEER 2009 cohort. Results Although the distribution of ELN count differed between the Chinese registry (n = 5,706) and the SEER database (n = 38,806; median, 15 versus seven, respectively), both cohorts exhibited significantly proportional increases from N0 to N1 and N2 disease (SEER OR, 1.038; China OR, 1.012; both P < .001) and serial improvements in OS (N0 disease: SEER HR, 0.986; China HR, 0.981; both P < .001; N1 and N2 disease: SEER HR, 0.989; China HR, 0.984; both P < .001) as the ELN count increased after controlling for confounders. Cut point analysis showed a threshold ELN count of 16 in patients with declared node-negative disease, which were examined in the derivation cohorts (SEER 2001 to 2008 HR, 0.830; China HR, 0.738) and validated in the SEER 2009 cohort (HR, 0.837). Conclusion A greater number of ELNs is associated with more-accurate node staging and better long-term survival of resected NSCLC. We recommend 16 ELNs as the cut point for evaluating the quality of LN examination or prognostic stratification postoperatively for patients with declared node-negative disease.
AB - Purpose We investigated the correlation between the number of examined lymph nodes (ELNs) and correct staging and long-term survival in non-small-cell lung cancer (NSCLC) by using large databases and determined the minimal threshold for the ELN count. Methods Data from a Chinese multi-institutional registry and the US SEER database on stage I to IIIA resected NSCLC (2001 to 2008) were analyzed for the relationship between the ELN count and stage migration and overall survival (OS) by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. The selected cut point was validated with the SEER 2009 cohort. Results Although the distribution of ELN count differed between the Chinese registry (n = 5,706) and the SEER database (n = 38,806; median, 15 versus seven, respectively), both cohorts exhibited significantly proportional increases from N0 to N1 and N2 disease (SEER OR, 1.038; China OR, 1.012; both P < .001) and serial improvements in OS (N0 disease: SEER HR, 0.986; China HR, 0.981; both P < .001; N1 and N2 disease: SEER HR, 0.989; China HR, 0.984; both P < .001) as the ELN count increased after controlling for confounders. Cut point analysis showed a threshold ELN count of 16 in patients with declared node-negative disease, which were examined in the derivation cohorts (SEER 2001 to 2008 HR, 0.830; China HR, 0.738) and validated in the SEER 2009 cohort (HR, 0.837). Conclusion A greater number of ELNs is associated with more-accurate node staging and better long-term survival of resected NSCLC. We recommend 16 ELNs as the cut point for evaluating the quality of LN examination or prognostic stratification postoperatively for patients with declared node-negative disease.
KW - Aged
KW - Carcinoma, Non-Small-Cell Lung/mortality
KW - China
KW - Female
KW - Humans
KW - Lung Neoplasms/mortality
KW - Lymph Nodes/pathology
KW - Lymphatic Metastasis
KW - Male
KW - Middle Aged
KW - Neoplasm Staging
KW - Regression Analysis
KW - Retrospective Studies
KW - SEER Program
KW - Survival Rate
KW - Time Factors
KW - United States
U2 - 10.1200/JCO.2016.67.5140
DO - 10.1200/JCO.2016.67.5140
M3 - Journal article
C2 - 28029318
SN - 0732-183X
VL - 35
SP - 1162
EP - 1170
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 11
ER -
