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. 2024 Dec 9:11:1506850.
doi: 10.3389/fsurg.2024.1506850. eCollection 2024.

Comparative evaluation of negative lymph node count, positive lymph node count, and lymph node ratio in prognostication of survival following completely resection for non-small cell lung cancer: a multicenter population-based analysis

Qiming Huang #  1 , Shai Chen #  2 , Yuanyuan Xiao  3   4 , Wei Chen  5 , Shancheng He  3   4 , Baochang Xie  3   4 , Wenqi Zhao  3   4 , Yuhui Xu  6 , Guiping Luo  7
Affiliations

Comparative evaluation of negative lymph node count, positive lymph node count, and lymph node ratio in prognostication of survival following completely resection for non-small cell lung cancer: a multicenter population-based analysis

Qiming Huang et al. Front Surg. .

Abstract

Objective: Lung cancer is the leading cause of cancer-related mortality. Lymph node involvement remains a crucial prognostic factor in non-small cell lung cancer (NSCLC), and the TNM system is the current standard for staging. However, it mainly considers the anatomical location of lymph nodes, neglecting the significance of node count. Metrics like metastatic lymph node count and lymph node ratio (LNR) have been proposed as more accurate predictors.

Methods: We used data from the SEER 17 Registry Database (2010-2019), including 52,790 NSCLC patients who underwent lobectomy or pneumonectomy, with at least one lymph node examined. Primary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression models assessed the prognostic value of negative lymph node (NLN) count, number of positive lymph node (NPLN), and LNR, with cut-points determined using X-tile software. Model performance was evaluated by the Akaike information criterion (AIC).

Results: The Cox proportional hazards model analysis revealed that NLN, NPLN, and LNR are independent prognostic factors for OS and LCSS (P < 0.0001). Higher NLN counts were associated with better survival (HR = 0.79, 95% CI = 0.76-0.83, P < 0.0001), while higher NPLN (HR = 2.19, 95% CI = 1.79-2.67, P < 0.0001) and LNR (HR = 1.64, 95% CI = 1.79-2.67, P < 0.0001) values indicated worse outcomes. Kaplan-Meier curves for all three groups (NLN, NPLN, LNR) demonstrated clear stratification (P < 0.0001). The NLN-based model (60,066.5502) exhibited the strongest predictive performance, followed by the NPLN (60,508.8957) and LNR models (60,349.4583), although the differences in AIC were minimal.

Conclusions: NLN count, NPLN, and LNR were all identified as independent prognostic indicators in patients with NSCLC. Among these, the predictive model based on NLN demonstrated a marginally superior prognostic value compared to NPLN, with NPLN outperforming the LNR model. Notably, higher NLN counts, along with lower NPLN and LNR values, were consistently associated with improved survival outcomes. The relationship between these prognostic markers and NSCLC survival warrants further validation through prospective studies.

Keywords: NSCLC; SEER; negative lymph node; prognostication; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Survival stratified by NLN, NPLN, LNR among patients. (A) OS, Stratified by NLN; (B) OS, Stratified by NPLN; (C) OS, Stratified by LNR; (D) CSS, Stratified by NLN; (E) CSS, Stratified by NPLN; (F) CSS, Stratified by LNR. OS, verall survival; CSS, cancer-specific survival; NLN, negative lymph node; NPLN, number of positive lymph node; LNR, lymph node ratio.
Figure 2
Figure 2
Survival stratified by positive or negative lymph nodes among patients. (A) OS, People with negative lymph nodes; (B) CSS, People with negative lymph nodes; (C) OS, People with positive lymph nodes; (D) CSS, People with positive lymph nodes; OS, verall survival; CSS, cancer-specific survival.
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