Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer

Matthew D. Taylor, Damien J. Lapar, Christopher J. Thomas, Matthew Persinger, Edward B. Stelow, Benjamin D. Kozower, Christine L. Lau, David R. Jones

Research output: Contribution to journalArticle

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Abstract

Background: Current TNM non-small cell lung cancer (NSCLC) staging uses only the anatomic location of lymph nodes to define N status. Several other cancer staging systems have found lymph node ratio (LNR) - the number of positive lymph nodes/total lymph nodes resected - to be a better predictor of survival after resection. The purpose of this study is to evaluate LNR as a predictor of recurrence and survival after R0 resection for NSCLC. Methods: A total of 1,143 consecutive patients underwent R0 resection for NSCLC between 1999 and 2008 at a high-volume single institution with 26% (n = 302) having N1 and N2 disease. The primary endpoints of the study were long-term survival and recurrence as a function of LNR. Cox proportional hazard models and Kaplan-Meier survival analyses were utilized to assess associations between LNR, N status, and pathologic stage with survival and recurrence after lung cancer resection. Results: Median follow-up was 44 months and was complete in 97% of patients. Nodal status of patients in this study was as follows: N0 disease, 73.5%; N1 disease, 18.7%; and N2 disease, 7.8%. There were 132 recurrences in patients with nodal disease (43.7%). The pathologic stage of patients in the study was as follows: stage IIA, 47%; stage IIB, 17%; stage IIIA, 35%; and stage IIIB, 1%. Mean total number of lymph nodes sampled was 11.1 ± 6.0 and mean number of positive lymph nodes 2.4 ± 2.0. Upon statistical modeling, LNR was found to be independently associated with decreased survival after resection for NSCLC (hazard ratio 2.63, confidence interval: 1.41 to 4.91, p = 0.002). Conclusions: In patients undergoing resection for NSCLC, increasing lymph node ratio is independently associated with decreased survival and decreased time to recurrence after R0 resection.

Original languageEnglish (US)
Pages (from-to)1163-1170
Number of pages8
JournalAnnals of Thoracic Surgery
Volume96
Issue number4
DOIs
StatePublished - Oct 1 2013

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Non-Small Cell Lung Carcinoma
Lymph Nodes
Recurrence
Survival
Neoplasm Staging
Kaplan-Meier Estimate
Survival Analysis
Proportional Hazards Models
Lung Neoplasms
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Taylor, M. D., Lapar, D. J., Thomas, C. J., Persinger, M., Stelow, E. B., Kozower, B. D., ... Jones, D. R. (2013). Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer. Annals of Thoracic Surgery, 96(4), 1163-1170. https://doi.org/10.1016/j.athoracsur.2013.04.031
Taylor, Matthew D. ; Lapar, Damien J. ; Thomas, Christopher J. ; Persinger, Matthew ; Stelow, Edward B. ; Kozower, Benjamin D. ; Lau, Christine L. ; Jones, David R. / Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer. In: Annals of Thoracic Surgery. 2013 ; Vol. 96, No. 4. pp. 1163-1170.
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title = "Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer",
abstract = "Background: Current TNM non-small cell lung cancer (NSCLC) staging uses only the anatomic location of lymph nodes to define N status. Several other cancer staging systems have found lymph node ratio (LNR) - the number of positive lymph nodes/total lymph nodes resected - to be a better predictor of survival after resection. The purpose of this study is to evaluate LNR as a predictor of recurrence and survival after R0 resection for NSCLC. Methods: A total of 1,143 consecutive patients underwent R0 resection for NSCLC between 1999 and 2008 at a high-volume single institution with 26{\%} (n = 302) having N1 and N2 disease. The primary endpoints of the study were long-term survival and recurrence as a function of LNR. Cox proportional hazard models and Kaplan-Meier survival analyses were utilized to assess associations between LNR, N status, and pathologic stage with survival and recurrence after lung cancer resection. Results: Median follow-up was 44 months and was complete in 97{\%} of patients. Nodal status of patients in this study was as follows: N0 disease, 73.5{\%}; N1 disease, 18.7{\%}; and N2 disease, 7.8{\%}. There were 132 recurrences in patients with nodal disease (43.7{\%}). The pathologic stage of patients in the study was as follows: stage IIA, 47{\%}; stage IIB, 17{\%}; stage IIIA, 35{\%}; and stage IIIB, 1{\%}. Mean total number of lymph nodes sampled was 11.1 ± 6.0 and mean number of positive lymph nodes 2.4 ± 2.0. Upon statistical modeling, LNR was found to be independently associated with decreased survival after resection for NSCLC (hazard ratio 2.63, confidence interval: 1.41 to 4.91, p = 0.002). Conclusions: In patients undergoing resection for NSCLC, increasing lymph node ratio is independently associated with decreased survival and decreased time to recurrence after R0 resection.",
author = "Taylor, {Matthew D.} and Lapar, {Damien J.} and Thomas, {Christopher J.} and Matthew Persinger and Stelow, {Edward B.} and Kozower, {Benjamin D.} and Lau, {Christine L.} and Jones, {David R.}",
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Taylor, MD, Lapar, DJ, Thomas, CJ, Persinger, M, Stelow, EB, Kozower, BD, Lau, CL & Jones, DR 2013, 'Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer', Annals of Thoracic Surgery, vol. 96, no. 4, pp. 1163-1170. https://doi.org/10.1016/j.athoracsur.2013.04.031

Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer. / Taylor, Matthew D.; Lapar, Damien J.; Thomas, Christopher J.; Persinger, Matthew; Stelow, Edward B.; Kozower, Benjamin D.; Lau, Christine L.; Jones, David R.

In: Annals of Thoracic Surgery, Vol. 96, No. 4, 01.10.2013, p. 1163-1170.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Lymph node ratio predicts recurrence and survival after R0 resection for non-small cell lung cancer

AU - Taylor, Matthew D.

AU - Lapar, Damien J.

AU - Thomas, Christopher J.

AU - Persinger, Matthew

AU - Stelow, Edward B.

AU - Kozower, Benjamin D.

AU - Lau, Christine L.

AU - Jones, David R.

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Background: Current TNM non-small cell lung cancer (NSCLC) staging uses only the anatomic location of lymph nodes to define N status. Several other cancer staging systems have found lymph node ratio (LNR) - the number of positive lymph nodes/total lymph nodes resected - to be a better predictor of survival after resection. The purpose of this study is to evaluate LNR as a predictor of recurrence and survival after R0 resection for NSCLC. Methods: A total of 1,143 consecutive patients underwent R0 resection for NSCLC between 1999 and 2008 at a high-volume single institution with 26% (n = 302) having N1 and N2 disease. The primary endpoints of the study were long-term survival and recurrence as a function of LNR. Cox proportional hazard models and Kaplan-Meier survival analyses were utilized to assess associations between LNR, N status, and pathologic stage with survival and recurrence after lung cancer resection. Results: Median follow-up was 44 months and was complete in 97% of patients. Nodal status of patients in this study was as follows: N0 disease, 73.5%; N1 disease, 18.7%; and N2 disease, 7.8%. There were 132 recurrences in patients with nodal disease (43.7%). The pathologic stage of patients in the study was as follows: stage IIA, 47%; stage IIB, 17%; stage IIIA, 35%; and stage IIIB, 1%. Mean total number of lymph nodes sampled was 11.1 ± 6.0 and mean number of positive lymph nodes 2.4 ± 2.0. Upon statistical modeling, LNR was found to be independently associated with decreased survival after resection for NSCLC (hazard ratio 2.63, confidence interval: 1.41 to 4.91, p = 0.002). Conclusions: In patients undergoing resection for NSCLC, increasing lymph node ratio is independently associated with decreased survival and decreased time to recurrence after R0 resection.

AB - Background: Current TNM non-small cell lung cancer (NSCLC) staging uses only the anatomic location of lymph nodes to define N status. Several other cancer staging systems have found lymph node ratio (LNR) - the number of positive lymph nodes/total lymph nodes resected - to be a better predictor of survival after resection. The purpose of this study is to evaluate LNR as a predictor of recurrence and survival after R0 resection for NSCLC. Methods: A total of 1,143 consecutive patients underwent R0 resection for NSCLC between 1999 and 2008 at a high-volume single institution with 26% (n = 302) having N1 and N2 disease. The primary endpoints of the study were long-term survival and recurrence as a function of LNR. Cox proportional hazard models and Kaplan-Meier survival analyses were utilized to assess associations between LNR, N status, and pathologic stage with survival and recurrence after lung cancer resection. Results: Median follow-up was 44 months and was complete in 97% of patients. Nodal status of patients in this study was as follows: N0 disease, 73.5%; N1 disease, 18.7%; and N2 disease, 7.8%. There were 132 recurrences in patients with nodal disease (43.7%). The pathologic stage of patients in the study was as follows: stage IIA, 47%; stage IIB, 17%; stage IIIA, 35%; and stage IIIB, 1%. Mean total number of lymph nodes sampled was 11.1 ± 6.0 and mean number of positive lymph nodes 2.4 ± 2.0. Upon statistical modeling, LNR was found to be independently associated with decreased survival after resection for NSCLC (hazard ratio 2.63, confidence interval: 1.41 to 4.91, p = 0.002). Conclusions: In patients undergoing resection for NSCLC, increasing lymph node ratio is independently associated with decreased survival and decreased time to recurrence after R0 resection.

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