淋巴结检出数目对pT1c-3N0M0非小细胞肺癌患者预后分析

Analysis of the number of lymph nodes examined on the prognosis of pT1c-3N0M0 non-small cell lung cancer patients

目的探讨不同淋巴结检出数目对pT1c-3N0M0非小细胞肺癌(NSCLC)患者预后影响。同时探讨合适的N1站淋巴结检出数目对pT1c-3N0M0 NSCLC患者预后影响。方法回顾性分析2015年1月至2015年12月在中国科学技术大学附属第一医院胸外科接受肺癌根治术的pT1c-3N0M0 NSCLC患者203例,通过单因素及多因素分析不同淋巴结检出数目对pT1c-3N0M0 NSCLC患者预后影响。同时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pT1c-3N0M0 NSCLC患者5年生存的最佳界值。结果全组患者共检出淋巴结3156枚,人均检出淋巴结15.5枚。淋巴结检出0~10枚组中位生存时间及第1、3、5年生存率分别为55个月、77.4%、56.3%、41.6%。11~16枚组中位生存时间及第1、3、5年生存率分别为66个月、84.7%、74.3%、56.9%。>16枚组中位生存时间及第1、3、5年生存率分别为68个月、91.0%、71.6%、61.0%,差异有统计学意义(c2=23.844,P<0.001)。多因素分析显示,淋巴结检出数目、T分期和肿瘤最大径是pT1c-3N0M0 NSCLC患者预后的独立影响因素(均P<0.05)。ROC曲线分析显示,N1站淋巴结检出数目预测pT1c-3N0M0 NSCLC患者5年生存的曲线下面积为0.646。当N1站淋巴结检出数目为4.5枚时,Youden指数最大。结论不同的淋巴结检出数目是pT1c-3N0M0 NSCLC患者独立预后影响因素。另外,对于N1站淋巴结至少应检出5枚及以上。

Objective To investigate the prognostic impact of different numbers of lymph nodes examined on pT1c-3N0M0 non-small cell lung cancer(NSCLC)patients,and also to investigate the prognostic impact of the appropriate number of lymph nodes examined at station N1 on pT1c-3N0M0 NSCLC patients.Methods A retrospective analysis of 203 patients with pT1c-3N0M0 NSCLC who underwent radical lung cancer surgery in the Department of Thoracic Surgery of the First Affiliated Hospital of the University of Science and Technology of China from January 2015 to December 2015 was conducted to analyze the prognostic impact of different numbers of lymph nodes detected on pT1c-3N0M0 NSCLC patients by univariate and multifactorial analysis.The analysis of subject operating characteristic(ROC)curves was also used to determine the optimal cut-off value for predicting 5-year survival of pT1c-3N0M0 NSCLC patients by the number of lymph nodes examined at N1 station.Results A total of 3156 lymph nodes were examined in the whole group,with 15.5 lymph nodes examined per capital.The median survival time and the survival rates at 1,3 and 5 years for the group with 0~10 lymph nodes examined were 55 months,77.4%,56.3%and 41.6%,respectively.The median survival time and the survival rates at 1,3 and 5 years for the group with 11~16 lymph nodes examined were 66 months,84.7%,74.3%and 56.9%,respectively.The median survival time and the survival rate of 1,3,and 5 years in the>16 lymph nodes examined were 68 months,91.0%,71.6%,and 61.0%,respectively(χ^(2)=23.844,P<0.001).Multifactorial analysis showed that the number of lymph nodes examined,T-stage and maximum tumor diameter were independent factors influencing the prognosis of pT1c-3N0M0 NSCLC patients(all P<0.05).ROC curve analysis showed that the area under the curve for the number of lymph nodes examined at station N1 to predict 5-year survival in pT1c-3N0M0 NSCLC patients was 0.646.When the number of lymph nodes examined at N1 station was 4.5,the Youden index was maximum.Conclusion The different number of lymph nodes examined is an independent prognostic influence for patients with pT1c-3N0M0 NSCLC.In addition,at least 5 and more lymph nodes should be examined for N1 station lymph nodes.