Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non–Small-Cell Lung Cancer: A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry


Liang Wenhua1,He Jiaxi1,Shen Yaxing1,Shen Jianfei1,He Qihua1,Zhang Jianrong1,Jiang Gening1,Wang Qun1,Liu Lunxu1,Gao Shugeng1,Liu Deruo1,Wang Zheng1,Zhu Zhihua1,Ng Calvin S.H.1,Liu Chia-chuan1,Horsleben Petersen René1,Rocco Gaetano1,D’Amico Thomas1,Brunelli Alessandro1,Chen Haiquan1,Zhi Xiuyi1,Liu Bo1,Yang Yixin1,Chen Wensen1,Zhou Qian1,He Jianxing1


1. Wenhua Liang, Jiaxi He, Jianfei Shen, Qihua He, Jianrong Zhang, and Jianxing He, The First Affiliated Hospital of Guangzhou Medical University; Wenhua Liang, Jiaxi He, Jianfei Shen, Qihua He, Jianrong Zhang, and Jianxing He, Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease; Zhihua Zhu, Cancer Center of Sun Yat-Sen University; Qian Zhou, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou; Jianfei Shen, Taizhou Hospital of Zhejiang Province,...


Purpose We investigated the correlation between the number of examined lymph nodes (ELNs) and correct staging and long-term survival in non–small-cell lung cancer (NSCLC) by using large databases and determined the minimal threshold for the ELN count. Methods Data from a Chinese multi-institutional registry and the US SEER database on stage I to IIIA resected NSCLC (2001 to 2008) were analyzed for the relationship between the ELN count and stage migration and overall survival (OS) by using multivariable models. The series of the mean positive LNs, odds ratios (ORs), and hazard ratios (HRs) were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. The selected cut point was validated with the SEER 2009 cohort. Results Although the distribution of ELN count differed between the Chinese registry (n = 5,706) and the SEER database (n = 38,806; median, 15 versus seven, respectively), both cohorts exhibited significantly proportional increases from N0 to N1 and N2 disease (SEER OR, 1.038; China OR, 1.012; both P < .001) and serial improvements in OS (N0 disease: SEER HR, 0.986; China HR, 0.981; both P < .001; N1 and N2 disease: SEER HR, 0.989; China HR, 0.984; both P < .001) as the ELN count increased after controlling for confounders. Cut point analysis showed a threshold ELN count of 16 in patients with declared node-negative disease, which were examined in the derivation cohorts (SEER 2001 to 2008 HR, 0.830; China HR, 0.738) and validated in the SEER 2009 cohort (HR, 0.837). Conclusion A greater number of ELNs is associated with more-accurate node staging and better long-term survival of resected NSCLC. We recommend 16 ELNs as the cut point for evaluating the quality of LN examination or prognostic stratification postoperatively for patients with declared node-negative disease.


American Society of Clinical Oncology (ASCO)


Cancer Research,Oncology







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