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Original Research: LUNG CANCER |

The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung CancerLymph Node Metastases in Lung Cancer

Sirisha Jonnalagadda, BA; Cardinale Smith, MD; Grace Mhango, MPH; Juan P. Wisnivesky, MD, DrPH
Author and Funding Information

From the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (Ms Jonnalagadda), Piscataway, NJ; the Division of Hematology and Oncology and Palliative Care Medicine (Dr Smith), the Division of General Internal Medicine (Ms Mhango and Dr Wisnivesky), and the Division of Pulmonary and Critical Care Medicine (Dr Wisnivesky), Mount Sinai School of Medicine, New York, NY.

Correspondence to: Juan P. Wisnivesky, MD, DrPH, Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029; e-mail: juan.wisnivesky@mssm.edu


Funding/Support: This study was supported by the Doris Duke Charitable Foundation for Clinical Research and, in part, by the National Cancer Institute [Grant 5R01CA131348-03].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):433-440. doi:10.1378/chest.10-2885
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Background:  Lymph node (LN) status is an important component of staging; it provides valuable prognostic information and influences treatment decisions. However, the prognostic significance of the number of positive LNs in N1 non-small cell lung cancer (NSCLC) remains unclear. In this study we evaluated whether a higher number of positive LNs results in worse survival among patients with N1 disease.

Methods:  The Surveillance, Epidemiology, and End Results database was used to identify 3,399 patients who underwent resection for N1 NSCLC. Subjects were categorized into groups based on the number of positive nodes: one, two to three, four to eight, and more than eight positive LNs. The prognostic significance of the number of positive LNs in relation to survival was evaluated using the Kaplan-Meier method. Stratified and Cox regression analysis were used to evaluate the relationship between the number of positive LNs and survival after adjusting for potential confounders.

Results:  Unadjusted survival analysis showed that a greater number of N1 LNs was associated with worse lung cancer-specific (P < .0001) and overall (P < .0001) survival. Mean lung cancer-specific survival was 8.8, 8.2, 6.0, and 3.9 years for patients with one, two to three, four to eight, and more than eight positive LNs, respectively. Stratified and adjusted analysis also showed the number of N1 LNs was an independent predictor of survival after controlling for potential confounders.

Conclusion:  The number of positive LNs is an independent prognostic factor of survival in patients with N1 NSCLC. This information may be used to further stratify patients with respect to risk of recurrence in order to determine postoperative management.

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