淋巴结转移率与Ⅲa-N2非小细胞肺癌临床特征和生存相关性研究

BACKGROUND AND OBJECTIVE: Ⅲa-N2 non-small cell lung cancer was significant different in survival, although N stage of lung cancer based on anatomic location of metastasis lymph node. Lymph node ratio considered of prognostic factor might be the evaluation index for Ⅲa-N2 non-small cell lung cancer prognosis. Therefore, the aim of the study was to evaluate the correlation between lymph node ratio and clinicopathological features and prognosis of Ⅲa-N2 non-small cell lung cancer prognosis. METHODS: A total of 288 cases of pathological Ⅲa-N2 non-small cell lung cancer were enrolled who received radical resection at the Department of Thoracic Surgery Ⅱ, Peking University Cancer Hospital from January 2006 to December 2016. The univariate analysis between clinicopathological variables and lymph node ratio used Pearson's chi-squared test. Cox regression was conducted to identify the independent prognosis factors for Ⅲa-N2 non-small cell lung cancer. RESULTS: There were 139 cases in the lower lymph node ratio group, another 149 cases in the higher lymph node ratio group. Adenocarcinoma (χ(2)=5.924, P=0.015), highest mediastinal lymph node metastasis (χ(2)=46.136, P < 0.001), multiple-number N2 metastasis (χ(2)=59.347, P < 0.001), multiple-station N2 metastasis (χ(2)=77.387, P < 0.001) and skip N2 lymph node metastasis (χ(2)=61.524, P < 0.001) significantly impacted lymph node ratio. The total number of lymph node dissection was not correlated with the lymph node ratio (χ(2)=0.537, P=0.464). Cox regression analysis confirmed that adenocarcinoma (P=0.008), multiple-number N2 metastasis (P=0.025) and lymph node ratio (P=0.001) were the independent prognosis factors of disease free survival. The 5-year disease free survival was 18.1% in the higher lymph node ratio group, and 44.1% in the lower. Lymph node ratio was the independent prognosis factor of overall survival (P < 0.001). The 5-year overall survival was 36.7% in the higher lymph node ratio group, and 64.1% in the lower. CONCLUSION: Lymph node ratio was correlative with the pathology, highest mediastinal lymph node metastasis, multiple-number N2 metastasis, multiple-station N2 metastasis and skip N2 lymph node metastasis. Lymph node ratio was the independent prognosis factor for Ⅲa-N2 non-small cell lung cancer.