Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 8, pp 2115–2122 | Cite as

A prognostic score system with lymph node ratio in stage IIIA-N2 NSCLC patients after surgery and adjuvant chemotherapy

  • Han Han
  • Yue Zhao
  • Zhendong Gao
  • Difan Zheng
  • Fangqiu Fu
  • Zitong Zhao
  • Ya Tang
  • Jiaqing Xiang
  • Yihua Sun
  • Hong Hu
  • Haiquan ChenEmail author
Original Article – Clinical Oncology



The survival of patients with IIIA-N2 non-small cell lung cancer after surgery followed by adjuvant chemotherapy is heterogeneous. The aim of this study is to form a prognostic system and a heat map method to visualize the overall survival rates in those patients.


Univariate and multivariate Cox hazards regression models and the associated Wald Chi square coefficient were used to form the prognostic score system. Recursive partitioning analysis was used to determine the cutoff values of lymph node ratio and prognostic score in SEER cohort and validated in FDUSCC cohort. Meanwhile, a heat map method was used to visualize the overall survival probabilities of 3, 5 and 10 years for individual patient of both cohorts.


Lymph node ratio (with cutoff of 0.36) significantly correlates with overall survival of these patients. In addition, in patients with the same level of N2 disease, lymph node ratio still significantly affects survival. Also, after the multivariate analysis in SEER cohort, six factors were independent prognostic factors including age, sex, type of surgery, size, lymph node ratio and differentiation. A prognostic sore system with these factors (with cutoff of 12) was validated as a predictor for overall survival in FDUSCC cohort.


This prognostic score system including lymph node ratio can predict the survival rates of IIIA-N2 patient after surgery and post-operative chemotherapy. Lymph node ratio could be a useful supplementation in TNM stage classification for IIIA-N2 patients. The heat map method can visualize the predicted overall survival of an individual patient.


Non-small cell lung cancer Surgery Adjuvant chemotherapy Mediastinal lymph node metastasis 



Non-small cell lung cancer


Surveillance, epidemiology, and end results


Fudan University Shanghai Cancer Center


Lymph node ratio



This work was funded by the National Natural Science Foundation of China (81572253 and 81702258), Chinese Minister of Science and Technology grant (2017YFA0505501) and Shanghai Paramount Importance Subject—Thoracic Surgery (2017ZZ02025).

Compliance with ethical standards

Conflict of interest

Han Han declares that he has no conflict of interest. Yue Zhao declares that he has no conflict of interest. Zhendong Gao declares that he has no conflict of interest. Difan Zheng declares that he has no conflict of interest. Fangqiu Fu declares that he has no conflict of interest. Zitong Zhao declares that he has no conflict of interest. Ya Tang declares that he has no conflict of interest. Jiaqing Xiang declares that he has no conflict of interest. Yihua Sun declares that he has no conflict of interest. Hong Hu declares that he has no conflict of interest. Haiquan Chen declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryFudan University Shanghai Cancer CenterShanghaiChina
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina

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