Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr;66(4):287-93.
doi: 10.1136/thx.2010.148601. Epub 2010 Dec 2.

Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer

Juan P Wisnivesky  1 , Jacqueline Arciniega, Grace Mhango, John Mandeli, Ethan A Halm
Affiliations

Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer

Juan P Wisnivesky et al. Thorax. 2011 Apr.

Abstract

Background: Lymph node (LN) metastasis is an important predictor of survival for patients with non-small cell lung cancer (NSCLC). However, the prognostic significance of the extent of LN involvement among patients with N1 disease remains unknown. A study was undertaken to evaluate whether involvement of a higher number of N1 LNs is associated with worse survival independent of known prognostic factors.

Methods: Using the Surveillance, Epidemiology and End Results-Medicare database, 1682 resected patients with N1 NSCLC diagnosed between 1992 and 2005 were identified. As the number of positive LNs is confounded by the total number of LNs sampled, the cases were classified into three groups according to the ratio of positive to total number of LNs removed (LN ratio (LNR)): ≤0.15, 0.16-0.5 and >0.5. Lung cancer-specific and overall survival was compared between these groups using Kaplan-Meier curves. Stratified and Cox regression analyses were used to evaluate the relationship between the LNR and survival after adjusting for potential confounders.

Results: Lung cancer-specific and overall survival was lower among patients with a high LNR (p<0.0001 for both comparisons). Median lung cancer-specific survival was 47 months, 37 months and 21 months for patients in the ≤0.15, 0.16-0.5 and >0.5 LNR groups, respectively. In stratified and adjusted analyses, a higher LNR was also associated with worse lung cancer-specific and overall survival.

Conclusions: The extent of LN involvement provides independent prognostic information in patients with N1 NSCLC. This information may be used to identify patients at high risk of recurrence who may benefit from aggressive postoperative therapy.

PubMed Disclaimer

Conflict of interest statement

Competing interests JPW is a member of the research board of EHE International and has received a grant from Glaxo Smith Kline for a COPD study and lecture fees from Novartis Pharmaceuticals.

Figures

Figure 1
Figure 1
(A) Lung cancer-specific and (B) overall survival according to the ratio of positive to total N1 lymph nodes examined. LNR, lymph node ratio.
Figure 2
Figure 2
Lung cancer-specific and overall survival according to the ratio of positive to total N1 lymph nodes examined during surgery among patients with (A, B) T1; (C, D) T2; and (E, F) T3 disease.
See this image and copyright information in PMC

Comment in

References

    1. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest. 1997;111:1718–23. - PubMed
    1. Tanaka F, Yanagihara K, Otake Y, et al. Prognostic factors in patients with resected pathologic (p-) T1-2N1M0 non-small cell lung cancer (NSCLC) Eur J Cardiothorac Surg. 2001;19:555–61. - PubMed
    1. van Rens MT, de la Riviere AB, Elbers HR, et al. Prognostic assessment of 2,361 patients who underwent pulmonary resection for non-small cell lung cancer, stage I, II, and IIIA. Chest. 2000;117:374–9. - PubMed
    1. van Velzen E, Snijder RJ, Brutel de la Riviere A, et al. Lymph node type as a prognostic factor for survival in T2 N1 M0 non-small cell lung carcinoma. Ann Thorac Surg. 1997;63:1436–40. - PubMed
    1. Martini N, Flehinger BJ, Nagasaki F, et al. Prognostic significance of N1 disease in carcinoma of the lung. J Thorac Cardiovasc Surg. 1983;86:646–53. - PubMed

Publication types

LinkOut - more resources