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
机构：[1]The First Affiliated Hospital of Guangzhou Medical University[2]Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease[3]Cancer Center of Sun Yat-Sen University[4]The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou[5]Taizhou Hospital of Zhejiang Province,Wenzhou Medical University, Linhai[6]Shanghai Zhongshan Hospital of Fudan University[7]Shanghai Pulmonary Hospital of Tongji University[8]Fudan University Shanghai Cancer Center, Shanghai[9]West China Hospital, Sichuan University, Chengdu[10]Cancer Institute & Hospital, Chinese Academy of Medical Sciences[11]Peking Union Medical College[12]National Cancer Center[13]China and Japan Friendship Hospital[14]Beijing Xuanwu Hospital of Capital Medical University首都医科大学宣武医院[15]Academy of Mathematics and Systems Science in the Chinese Academy of Sciences, Beijing[16]Shenzhen People’s Hospital, Shenzhen[17]The Chinese University of Hong Kong, Hong Kong, Special Administrative Region[18]Nanjing Medical University[19]the First Affiliated Hospital of Nanjing Medical University,Nanjing, People’s Republic of China[20]Sun Yat-Sen Cancer Center, Taipei, Republic of China[21]University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark[22]Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy[23]Duke University Medical Center, Durham, NC[24]St James’s University Hospital, Leeds, United Kingdom.
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. (C) 2016 by American Society of Clinical Oncology.
基金：
Science and Technology Planning Project of Guangdong Province, People's Republic of China [2007B031515017, 2008A030201024]; Science and Technology Planning Project of Guangzhou, People's Republic of China [2007Z1-E0111, 2007Z3-E0261]; Guangzhou Health and Medical Collaborative Innovative Major Special Projects [201400000001-2]; Guangdong Doctoral Launching Program [2014A030310460]; Doctoral Launching Program of Guangzhou Medical University [2014C27]; Chinese National Natural Science Foundation [81501996]
第一作者机构：[1]The First Affiliated Hospital of Guangzhou Medical University[2]Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease
共同第一作者：
通讯作者：
通讯机构：[*1]The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease and China State Key Laboratory of Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou 510120, Guangdong Province, People’s Republic of China
推荐引用方式(GB/T 7714)：
Wenhua Liang,Jiaxi He,Yaxing Shen,et al.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[J].JOURNAL OF CLINICAL ONCOLOGY.2017,35(11):1162-1170.doi:10.1200/JCO.2016.67.5140.
APA：
Wenhua Liang,Jiaxi He,Yaxing Shen,Jianfei Shen,Qihua He...&Jianxing He.(2017).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.JOURNAL OF CLINICAL ONCOLOGY,35,(11)
MLA：
Wenhua Liang,et al."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".JOURNAL OF CLINICAL ONCOLOGY 35..11(2017):1162-1170
医学