TY - JOUR
T1 - Lymph node ratio as a prognostic factor in elderly patients with pathological N1 non-small cell lung cancer
AU - Wisnivesky, Juan P.
AU - Arciniega, Jacqueline
AU - Mhango, Grace
AU - Mandeli, John
AU - Halm, Ethan A.
N1 - Funding Information:
The authors acknowledge the efforts of the Applied Research Branch, Division of Cancer Prevention and Population Science, National Cancer Institute; the Office of Information Services, and the Office of Strategic Planning, Center for Medicare and Medicaid Services; Information Management Services Inc; and the Surveillance, Epidemiology, and End Results Program tumour registries in the creation of the SEER-Medicare Database. The interpretation and reporting of these data are the sole responsibility of the authors.
PY - 2011/4
Y1 - 2011/4
N2 - Background: Lymph node (LN) metastasis is an important predictor of survival for patients with non-small cell lung cancer (NSCLC). However, the prognostic significance of the extent of LN involvement among patients with N1 disease remains unknown. A study was undertaken to evaluate whether involvement of a higher number of N1 LNs is associated with worse survival independent of known prognostic factors. Methods: Using the Surveillance, Epidemiology and End Results-Medicare database, 1682 resected patients with N1 NSCLC diagnosed between 1992 and 2005 were identified. As the number of positive LNs is confounded by the total number of LNs sampled, the cases were classified into three groups according to the ratio of positive to total number of LNs removed (LN ratio (LNR)): ≤0.15, 0.16-0.5 and >0.5. Lung cancer-specific and overall survival was compared between these groups using Kaplan - Meier curves. Stratified and Cox regression analyses were used to evaluate the relationship between the LNR and survival after adjusting for potential confounders. Results: Lung cancer-specific and overall survival was lower among patients with a high LNR (p<0.0001 for both comparisons). Median lung cancer-specific survival was 47 months, 37 months and 21 months for patients in the ≤0.15, 0.16-0.5 and >0.5 LNR groups, respectively. In stratified and adjusted analyses, a higher LNR was also associated with worse lung cancer-specific and overall survival. Conclusions: The extent of LN involvement provides independent prognostic information in patients with N1 NSCLC. This information may be used to identify patients at high risk of recurrence who may benefit from aggressive postoperative therapy.
AB - Background: Lymph node (LN) metastasis is an important predictor of survival for patients with non-small cell lung cancer (NSCLC). However, the prognostic significance of the extent of LN involvement among patients with N1 disease remains unknown. A study was undertaken to evaluate whether involvement of a higher number of N1 LNs is associated with worse survival independent of known prognostic factors. Methods: Using the Surveillance, Epidemiology and End Results-Medicare database, 1682 resected patients with N1 NSCLC diagnosed between 1992 and 2005 were identified. As the number of positive LNs is confounded by the total number of LNs sampled, the cases were classified into three groups according to the ratio of positive to total number of LNs removed (LN ratio (LNR)): ≤0.15, 0.16-0.5 and >0.5. Lung cancer-specific and overall survival was compared between these groups using Kaplan - Meier curves. Stratified and Cox regression analyses were used to evaluate the relationship between the LNR and survival after adjusting for potential confounders. Results: Lung cancer-specific and overall survival was lower among patients with a high LNR (p<0.0001 for both comparisons). Median lung cancer-specific survival was 47 months, 37 months and 21 months for patients in the ≤0.15, 0.16-0.5 and >0.5 LNR groups, respectively. In stratified and adjusted analyses, a higher LNR was also associated with worse lung cancer-specific and overall survival. Conclusions: The extent of LN involvement provides independent prognostic information in patients with N1 NSCLC. This information may be used to identify patients at high risk of recurrence who may benefit from aggressive postoperative therapy.
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U2 - 10.1136/thx.2010.148601
DO - 10.1136/thx.2010.148601
M3 - Article
C2 - 21131298
AN - SCOPUS:79953005546
SN - 0040-6376
VL - 66
SP - 287
EP - 293
JO - Thorax
JF - Thorax
IS - 4
ER -