+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Lymph node ratio may predict the benefit of postoperative radiotherapy in non-small-cell lung cancer

Lymph node ratio may predict the benefit of postoperative radiotherapy in non-small-cell lung cancer

Journal of Thoracic Oncology 8(7): 940-946

The use of postoperative radiotherapy (PORT) after resection of non-small-cell lung cancer (NSCLC) is controversial, with some evidence suggesting a benefit in patients with N2 disease. We assessed lymph node ratio (LNR) as a predictor of PORT benefit. By using the Surveillance, Epidemiology and End Results database, we analyzed resected, node-positive (N1-N2) NSCLC patients diagnosed between 1998 and 2009. LNR, (number of positive nodes/number of resected nodes) was categorized into four groups: LNR less than 12.5%, 12.5 to 24.9%, 25 to 49.9%, and 50% or more. Of 11,324 node-positive NSCLC patients identified, 6551 (57.9%) had N1 disease. The LNR was prognostic for survival in the entire cohort and within each nodal stage. The median survival in LNR groups 1, 2, 3, and 4 was 43, 40, 30, and 23 months in N1 disease and 40, 32, 27, and 22 months in N2 disease, respectively. PORT was associated with a worse survival on univariate analysis (hazard ratio [HR] =1.09; confidence interval [CI] 1.03-1.15; p = 0.002) but no effect on multivariate analysis (HR = 0.96; CI 0.90-1.02; p = 0.201). When analyzed by nodal stage, the benefit of PORT was limited to N2 disease (HR = 0.9; CI 0.84-0.99; p= 0.026) with no benefit in N1 disease (HR = 1.06; CI 0.97-1.15; p=0.2). After stratifying by LNR, the survival benefit of PORT was limited to those with N2 disease and an LNR of 50% or more. A high LNR is associated with a poorer survival in resected, node-positive NSCLC. The survival benefit associated with PORT in this disease seems to be limited to those with an LNR of 50% or more. This warrants further investigation in other cohorts and prospective studies.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 054200035

Download citation: RISBibTeXText

PMID: 23695418

DOI: 10.1097/JTO.0b013e318292c53e

Related references

Lymph node ratio may predict the benefit of postoperative radiotherapy in node-positive cervical cancer. Oncotarget 7(20): 29420-8, 2017

Benefits of postoperative radiotherapy in multimodality treatment of resected small-cell lung cancer with lymph node metastasis. European Journal of Surgical Oncology 40(9): 1156-1162, 2014

Comparison of the efficacy of radiotherapy between postoperative mediastinal lymph node recurrence and stage III disease in non-small cell lung cancer patients. Journal of B.U.On. 21(2): 333-340, 2016

Log odds of positive lymph nodes may predict survival benefit in patients with node-positive non-small cell lung cancer. Lung Cancer 122: 60-66, 2018

Benefits of postoperative thoracic radiotherapy for small cell lung cancer subdivided by lymph node stage: a systematic review and meta-analysis. Journal of Thoracic Disease 9(5): 1257-1264, 2017

Radiotherapy for postoperative thoracic lymph node recurrence of non-small-cell lung cancer provides better outcomes if the disease is asymptomatic and a single-station involvement. Journal of Thoracic Oncology 8(11): 1417-1424, 2014

The lymph node status and histologic subtypes influenced the effect of postoperative radiotherapy on patients with N2 positive IIIA non-small cell lung cancer. Journal of Surgical Oncology 2018, 2018

Lymph node ratio determines the benefit of adjuvant radiotherapy in pathologically 3 or less lymph node-positive prostate cancer after radical prostatectomy: a population-based analysis with propensity-score matching. Oncotarget 8(66): 110625-110634, 2018

Postoperative radiotherapy for patients with completely resected pathological stage IIIA-N2 non-small cell lung cancer: focusing on an effect of the number of mediastinal lymph node stations involved. Interactive Cardiovascular and Thoracic Surgery 7(4): 573-577, 2008

Stereotactic radiotherapy following chemo-radiotherapy for lymph node metastasis of stage III non-small-cell lung cancer. Gan to Kagaku Ryoho. Cancer and ChemoTherapy 38(12): 2191-2193, 2012

Benefit of sentinel lymph node mapping in non-small cell lung cancer. Annals of Thoracic and Cardiovascular Surgery 12(6): 381-382, 2007

The postoperative neutrophil-to-lymphocyte ratio and changes in this ratio predict survival after the complete resection of stage I non-small cell lung cancer. Oncotargets and Therapy 9: 6529-6537, 2016

A Proposal for Combination of Lymph Node Ratio and Anatomic Location of Involved Lymph Nodes for Nodal Classification in Non-Small Cell Lung Cancer. Journal of Thoracic Oncology 11(9): 1565-1573, 2017

Use of postoperative radiotherapy for node-positive non-small-cell lung cancer. Clinical Lung Cancer 4(1): 35-44, 2003

Radiotherapy for hilar or mediastinal lymph node metastases after definitive treatment with stereotactic body radiotherapy or surgery for stage I non-small cell lung cancer. Practical Radiation Oncology 2(4): E137-E143, 2012