N1站淋巴结检出数目对pT1~3N0M0非小细胞肺癌患者预后的影响

Impact of the examined number of lymph nodes at N1 station on the prognosis of patients with pT1-3N0M0 non-small cell lung cancer

目的探讨N1站淋巴结检出数目与pT1~3N0M0非小细胞肺癌(NSCLC)患者临床病理特征及预后的关系。方法选择2013年1月至2015年3月在安徽医科大学附属省立医院接受肺癌根治术的pT1~3N0M0 NSCLC患者337例, 采用受试者工作特征(ROC)曲线的分析确定以N1站淋巴结检出数目预测pT1~3N0M0 NSCLC患者5年生存的最佳界值, 根据最佳界值分组, 分析N1站淋巴结检出数目与pT1~3N0M0 NSCLC患者临床病理特征及预后的关系。结果 337例患者共检出N1站淋巴结1 321枚, 每例患者平均3.9枚。中位生存时间为42.0个月, 1、3、5年生存率分别为82.2%、57.1%和24.9%。ROC曲线分析显示, 以N1站淋巴结检出数目预测pT1~3N0M0 NSCLC患者5年生存的最佳界值4.5枚, 取整数后, 以N1站淋巴结检出数目为5枚作为界值, 将患者分为检出淋巴结<5枚组(212例)和检出淋巴结≥5枚组(125例)。检出淋巴结≥5枚组接受辅助化疗的患者比例为19.2%, 高于检出淋巴结<5枚组(9.0%, P=0.007), 两组患者其他临床病理特征差异均无统计学意义(均P>0.05)。检出淋巴结<5枚组患者的中位生存时间为38.0个月, 1、3、5年生存率分别为80.1%、52.5%和15.6%。检出淋巴结≥5枚组患者的中位生存时间为48.0个月, 1、3、5年生存率分别为85.6%、64.0%和36.0%。检出淋巴结≥5枚组患者的生存率优于检出淋巴结<5枚组(P=0.002)。多因素Cox回归分析显示, T分期(OR=1.408, 95%CI为1.118~1.670)和N1站淋巴结检出数目(OR=0.670, 95%CI为0.526~0.853)是pT1~3N0M0 NSCLC患者预后的独立影响因素。结论 N1站淋巴结检出数目与pT1~3N0M0 NSCLC患者的预后有关, 术后病理检查时至少检出5枚N1站淋巴结能提高患者的5年生存率。

Objective To investigate the relationship between the examined number of lymph nodes at the N1 station and the clinicopathological characteristics and prognosis of patients with pT1-3N0M0 non-small cell lung cancer(NSCLC).Methods A total of 337 patients with pT1-3N0M0 NSCLC who underwent radical lung cancer surgery at the Provincial Hospital Affiliated to Anhui Medical University from January 2013 to March 2015 were selected.The receiver operating characteristic(ROC)curve analysis was used to determine the optimal cut-off value for predicting 5-year survival in pT1-3N0M0 NSCLC patients by the examined number of lymph nodes at the N1 station.The relationships between the examined number of lymph nodes at the N1 station and the clinicopathological characteristics and prognosis of patients with pT1-3N0M0 NSCLC were analyzed according to the optimal cut-off group.Results A total of 1321 lymph nodes at N1 station were examined in 337 patients,with a mean of 3.9 nodes per patient.The median survival time was 42.0 months,with 1-,3-and 5-year survival rates of 82.2%,57.1%and 24.9%,respectively.ROC curve analysis showed that the optimal cut-off value of 4.5 lymph nodes examined at the N1 station was used to predict 5-year survival in patients with pT1-3N0M0 NSCLC.After rounding off the number,the number of lymph nodes examined at the N1 station was 5 as the cut-off value,and the patients were divided into the group with<5 lymph nodes examined(212 cases)and the group with≥5 lymph nodes examined(125 cases).The proportion of patients received adjuvant chemotherapy was 19.2%in the group with≥5 lymph nodes examined,which was higher than 9.0%in the group with<5 lymph nodes examined(P=0.007),and the differences in other clinicopathological characteristics between the two groups were not statistically significant(P>0.05).The median survival time for patients in the group with<5 lymph nodes examined was 38.0 months,with 1-,3-and 5-year survival rates of 80.1%,52.5%and 15.6%,respectively.The median survival time for patients in the group with≥5 lymph nodes examined was 48.0 months,and the 1-,3-and 5-year survival rates were 85.6%,64.0%and 36.0%,respectively.The survival rate of patients in the group with≥5 lymph nodes examined was better than that in the group with<5 lymph nodes examined(P=0.002).Multifactorial Cox regression analysis showed that T stage(OR=1.408,95%CI:1.118-1.670)and the examined number of lymph nodes at N1 station(OR=0.670,95%CI:0.526-0.853)were independent influence factors for the prognosis of pT1-3N0M0 NSCLC patients.Conclusion The examined number of lymph nodes at the N1 station is associated with the prognosis of patients with pT1-3N0M0 NSCLC,and the examination of at least 5 lymph nodes at N1 station at the time of postoperative pathological examination improves the 5-year survival rate of patients.