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The prognostic impact of lymph node metastasis in patients with non-small cell lung cancer and distant organ metastasis

  • Jie Yang
  • Aimei Peng
  • Bo Wang
  • Aaron M. Gusdon
  • Xiaoting Sun
  • Gening JiangEmail author
  • Peng ZhangEmail author
Research Paper
  • 17 Downloads

Abstract

This study aimed to identify the prognostic value of lymph node metastasis in patients with non-small cell lung cancer (NSCLC) and distant organ metastasis. A total of 42,613 NSCLC patients with distant metastasis from the surveillance, epidemiology, and end results database between 2010 and 2013 were included for analysis. The proportion of N0 stage in M1a patients was significantly higher than that in M1b patients, 34.0% and 22.7% respectively (P < 0.001). Compared with N0 patients, patients had higher odds of experiencing multiorgan metastases (MOM) if they had higher N stage at diagnoses (P < 0.001). The Kaplan–Meier curves suggested both M1a and M1b groups patients at stage N0 had better survival than those at higher N stage (P < 0.001). Further analysis indicated that better survival was observed in N0 stage compared with N2 or N3 stage if patients had bone metastasis, brain metastasis, or MOM (P < 0.001, P < 0.001, and P = 0.002, respectively), but there was no significant difference in survival among each N stage patients with liver metastasis only. Cox regression analysis showed that compared with N0 patients, higher hazard for disease-specific mortality was observed for patients with higher N stage. Among NSCLC patients with distant organ metastasis, lymph node metastasis was associated with higher odds of experiencing MOM and a worse prognosis in terms of longer survival except patients with liver metastasis. Better understandings of the role of lymphatic metastasis in M1 NSCLC could help clinicians with better management of the disease.

Keywords

Non-small cell lung cancer Lymph node metastasis Distant metastasis Prognosis SEER 

Abbreviations

AD

Adenocarcinoma

AJCC

American Joint Committee on Cancer

HRs

Hazard ratios

IASLC

International Association for the Study of Lung Cancer

IQR

Interquartile range

MOM

Multiorgan metastases

NSCLC

Non-small cell lung cancer

ORs

Odds ratios

SEER

Surveillance, epidemiology and end results

SQCC

Squamous cell carcinoma

TNM

Tumor, node, and metastasis

Notes

Acknowledgements

We would like to thank all the staff of National Cancer Institute for their effort to the SEER program.

Author Contributions

Conception and design: J.Y., G.J., and P.Z.; Acquisition, statistical analysis or interpretation of the data: All authors; Drafting of the manuscript: J.Y., A.P., and B.W.; All authors reviewed and approved the final version of the manuscript.

Funding

This work was supported by National Natural Science Foundation of China No. 81600052 (J. Y.) and the Fundamental Research Funds for the Central Universities No. 22120180022 (J. Y.).

Compliance with ethical standards

Conflicts of interest

The authors disclose no potential conflicts of interest related to this study.

Ethical approval

Our study was approved by the ethical committee board of Shanghai Pulmonary Hospital and complied with 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Thoracic Surgery, Shanghai Pulmonary HospitalTongji University School of MedicineShanghaiChina
  2. 2.Department of Respiratory Medicine, Shanghai Tenth People’s HospitalTongji UniversityShanghaiChina
  3. 3.Department of Thoracic Surgery, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina
  4. 4.Department of Neurology, Division of Neurocritical CareJohns Hopkins University School of MedicineBaltimoreUSA
  5. 5.Department of Health Services Research & AdministrationUniversity of Nebraska Medical CenterOmahaUSA

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