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Original Research: Lung Cancer |

Prognostic Significance of the Extent of Lymph Node Involvement in Stage II-N1 Non-small Cell Lung CancerStage II-N1 Non-Small Cell Lung Cancer

Zi-Ming Li, MD; Zheng-Ping Ding, MD; Qing-Quan Luo, MD; Chun-Xiao Wu, MD; Mei-Lin Liao, MD; Ying Zhen, MD; Zhi-Wei Chen, MD, PhD; Shun Lu, MD, PhD
Author and Funding Information

From the Shanghai Lung Cancer Center (Drs Li, Ding, Luo, Liao, Chen, and Lu), Shanghai Chest Hospital, Shanghai Jiao Tong University; and Shanghai Municipal Center for Disease Control & Prevention (Drs Wu and Zhen), Shanghai, China.

Correspondence to: Shun Lu, MD, PhD, Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 Huaihai W Rd, Shanghai 200030, China; e-mail: shun_lu2011@hotmail.com


Drs Li, Ding, Chen, and Lu contributed equally.

Funding/Support: This study was supported by grants from Youth Foundation of Shanghai Municipal Public Health Bureau [2010Y043]; International S&T Cooperation Program of China [2012DFG31320]; Shanghai Foundation for Leaders of Disciplines in Science, China [13XD1403300]; and Science and Technology Commission of Shanghai [06DZ19501].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):1253-1260. doi:10.1378/chest.13-0073
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Background:  The non-small cell lung cancer (NSCLC) staging system (published in 2009 in the seventh edition of the cancer staging manuals of the Union for International Cancer Control and American Joint Commission on Cancer) did not include any changes to current N descriptors for NSCLC. However, the prognostic significance of the extent of lymph node (LN) involvement (including the LN zones involved [hilar/interlobar or peripheral], cancer-involved LN ratios [LNRs], and the number of involved LNs) remains unknown. The aim of this report is to evaluate the extent of LN involvement and other prognostic factors in predicting outcome after definitive surgery among Chinese patients with stage II-N1 NSCLC.

Methods:  We retrospectively reviewed the clinicopathologic characteristics of 206 patients with stage II (T1a-T2bN1M0) NSCLC who had undergone complete surgical resection at Shanghai Chest Hospital from June 1999 to June 2009. Overall survival (OS) and disease-free survival (DFS) were compared using Kaplan-Meier statistical analysis. Stratified and Cox regression analyses were used to evaluate the relationship between the LN involvement and survival.

Results:  Peripheral zone LN involvement, cancer-involved LNR, smaller tumor size, and squamous cell carcinoma were shown to be statistically significant indicators of higher OS and DFS by univariate analyses. Visceral pleural involvement was also shown to share a statistically significant relationship with DFS by univariate analyses. Multivariate analyses showed that tumor size and zone of LN involvement were significant predictors of OS.

Conclusions:  Zone of N1 LN, LN ratios, and tumor size were found to provide independent prognostic information in patients with stage II NSCLC. This information may be used to stratify patients into groups by risk for recurrence.

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