Tumor Biology

, Volume 36, Issue 6, pp 4617–4625 | Cite as

The impact of positive nodal chain ratio on individualized multimodality therapy in non-small-cell lung cancer

  • Qinchen Cao
  • Baozhong Zhang
  • Lujun Zhao
  • Changli Wang
  • Liqun Gong
  • Jun Wang
  • Qingsong Pang
  • Kai Li
  • Weishuai Liu
  • Xue Li
  • Peng Wang
  • Ping Wang
Research Article


This study aimed to analyze the prognostic significance of the positive nodal chain ratio (NCR) in non-small-cell lung cancer (NSCLC). A total of 208 pIIIa-N2 NSCLC patients who underwent complete surgical resections with a systematic nodal dissection were enrolled. The median values of NCR and the positive lymph node ratio (LNR) were used to grouping patients. The differences of overall survival (OS) and disease-free survival (DFS) between the different groups were compared. The median values of NCR and LNR were 0.31 and 0.45, respectively. The patients were separated into group A (NCR ≤0.45 and LNR ≤0.31; 91 cases), group B (NCR ≤0.45 and LNR >0.31 or NCR >0.45 and LNR ≤0.31; 51 cases), and group C (NCR >0.45 and LNR >0.31; 66 cases) according to their combined LCR and LNR values. Groups A, B, and C exhibited significantly different prognoses (5-year OS: 43.7, 25.2, and 12.3 %, respectively, p < 0.0001; 5-year DFS: 30.4, 23.3, and 8.6 %, respectively, p < 0.0001). Multivariate analyses revealed that this novel grouping method based on the combination of NCR and LNR was an independent prognostic factor for 5-year OS and 5-year DFS in pIIIa-N2 NSCLC. In group C, patients who received no postoperative treatment, adjuvant chemotherapy alone, or chemoradiotherapy exhibited different 5-year OS rates (0.0, 11.6, and 37.5 %, respectively, p = 0.003) and 5-year DFS rates (0.0, 7.5, and 25.0 %, respectively, p = 0.009). Therefore, postoperative chemoradiotherapy may significantly improve the prognosis of patients displaying NCR >0.45 and LNR >0.31. NCR combined with LNR may be more effective to guide individualized multimodality therapy including postoperative chemoradiotherapy for pIIIa-N2 NSCLC.


Lymph node Non-small-cell lung cancer Prognosis Chemoradiotherapy 



This study was supported by Natural Science Foundation of China (No. 81372518) and the Tianjin Key Problem Tackling Project for Cancer Therapy (No. 12ZCDZSY 15900). Drs. Qinchen Cao and Baozhong Zhang contributed to data collection, follow-up of patients, analysis, and writing of the manuscript. Drs. Ping Wang and Lujun Zhao contributed to study concepts and design, analysis, critical revision of the article for important intellectual content, and final approval of the article. Drs. Weishuai Liu, Xue Li, and Peng Wang contributed to data collection and revision of the article. Drs. Jun Wang, Qingsong Pang, Changli Wang, Liqun Gong, and Kai Li contributed to verification of data collected and revision of the article.

Conflict of interest



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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Qinchen Cao
    • 1
  • Baozhong Zhang
    • 1
  • Lujun Zhao
    • 1
  • Changli Wang
    • 2
  • Liqun Gong
    • 2
  • Jun Wang
    • 1
  • Qingsong Pang
    • 1
  • Kai Li
    • 3
  • Weishuai Liu
    • 4
  • Xue Li
    • 1
  • Peng Wang
    • 1
  • Ping Wang
    • 1
  1. 1.Department of RadiotherapyTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjinChina
  2. 2.Department of Lung Cancer SurgeryTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjinChina
  3. 3.Department of Lung Cancer Internal MedicineTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjinChina
  4. 4.Department of Cancer Pain and Nutrition ManagementTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjinChina

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