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. 2020 Oct;12(10):5552-5560.
doi: 10.21037/jtd-20-1611.

Prognostic impact of lymph node ratio in patients with pT1-2N1M0 non-small cell lung cancer

Sumin Shin  1 , Danbee Kang  2 , Jong Ho Cho  1 , Yong Soo Choi  1 , Jhingook Kim  1 , Jae Ill Zo  1 , Young Mog Shim  1 , Hong Kwan Kim  1
Affiliations

Prognostic impact of lymph node ratio in patients with pT1-2N1M0 non-small cell lung cancer

Sumin Shin et al. J Thorac Dis. 2020 Oct.

Abstract

Background: This study evaluated the lymph node ratio (LNR) defined as the ratio of the number of metastatic lymph nodes to the number of dissected lymph nodes as a prognostic factor for survival in patients with pT1-2N1M0 non-small cell lung cancer (NSCLC).

Methods: We retrospectively reviewed 413 patients with pathologic T1-2N1M0 NSCLC after complete surgical resection and mediastinal LN dissection between January 2004 and December 2012. The cut-off value for LNR was determined using χ2 tests, which were calculated using Cox proportional hazards regression model. Based on this model, the optimal cut-off value for LNR was 0.1.

Results: The study included 337 males and 76 females with a mean age of 62 years (range, 34-83 years). Patients with a high LNR (≥0.1) were more likely to be female and have more adenocarcinomas compared with patients with a low LNR (<0.1). The overall survival (OS) and disease-free survival (DFS) rates were significantly worse in the high LNR group than the low LNR group (OS, 55.4% vs. 69.8%, respectively P=0.003; DFS, 33.2% vs. 61.7%, P<0.001). In the multivariate analysis, a high LNR was associated with significantly worse OS [adjusted hazard ratio (aHR), 2.69; 95% confidence interval (CI), 1.74-4.17] and DFS (aHR, 2.41; 95% CI, 1.57-3.68).

Conclusions: LNR is an independent prognostic factor for survival in patients with pT1-2N1M0 NSCLC. These findings may provide useful prognostic information to allow the selection of patients for more aggressive postoperative therapy or follow-up strategies.

Keywords: Lung neoplasm; lymph nodes; non-small cell lung cancer (NSCLC); prognosis; risk factors.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-1611). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram. NSCLC, non-small cell lung cancer.
Figure 2
Figure 2
Correlation between metastatic lymph node and lymph node ratio.
Figure 3
Figure 3
Overall survival and disease-free survival according to lymph node ratio (LNR). Kaplan-Meier curves showed that patients with high LNR (LNR≥0.1) had significantly poorer overall survival (A) and disease-free survival (B) compared to those with low LNR (LNR <0.1).
Figure 4
Figure 4
Hazard ratio (HR) for survival by lymph node ratio (LNR). The reference values (square dots) were set at the 50th percentile of the LNR. Y axis represents HR. HRs were obtained from Cox regression models adjusted for sex, age, pathologic stage, histology, surgical extent and adjuvant treatment. Histograms represent the frequency distributions of LNR (continuous variable). There was an increase in HR for OS (A) and DFS (B) when patients demonstrated LNR greater than 0.1.
See this image and copyright information in PMC

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