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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.

Publication ,  Journal Article
Liang, W; He, J; Shen, Y; Shen, J; He, Q; Zhang, J; Jiang, G; Wang, Q; Liu, L; Gao, S; Liu, D; Wang, Z; Zhu, Z; Ng, CSH; Liu, C-C; Chen, H ...
Published in: J Clin Oncol
April 10, 2017

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.

Duke Scholars

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

April 10, 2017

Volume

35

Issue

11

Start / End Page

1162 / 1170

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • SEER Program
  • Retrospective Studies
  • Regression Analysis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Liang, W., He, J., Shen, Y., Shen, J., He, Q., Zhang, J., … Zhou, Q. (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. J Clin Oncol, 35(11), 1162–1170. https://doi.org/10.1200/JCO.2016.67.5140
Liang, Wenhua, Jiaxi He, Yaxing Shen, Jianfei Shen, Qihua He, Jianrong Zhang, Gening Jiang, 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 Clin Oncol 35, no. 11 (April 10, 2017): 1162–70. https://doi.org/10.1200/JCO.2016.67.5140.
Liang W, He J, Shen Y, Shen J, He Q, Zhang J, Jiang G, Wang Q, Liu L, Gao S, Liu D, Wang Z, Zhu Z, Ng CSH, Liu C-C, Petersen RH, Rocco G, D’Amico T, Brunelli A, Chen H, Zhi X, Liu B, Yang Y, Chen W, Zhou Q. 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 Clin Oncol. 2017 Apr 10;35(11):1162–1170.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

April 10, 2017

Volume

35

Issue

11

Start / End Page

1162 / 1170

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Survival Rate
  • SEER Program
  • Retrospective Studies
  • Regression Analysis
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male