Proposal of new nodal classifications for non-small-cell lung cancer based on the number and ratio of metastatic lymph nodes

Abstract

The LNR followed by the number of metastatic LNs may be more effective prognostic indicators than the current nodal classification based on the location of metastatic LNs. For the future revision, the number of metastatic LNs and LNR should be evaluated as indicators for the nodal classification of lung cancer.

Microscopic N2 disease exhibits a better prognosis in resected non-small-cell lung cancer

“…Indeed, the definition of Meacci et al [12] represents the LNR, as does the definition provided by Dooms et al [11]. Nevertheless, as previously reported by our team and others [4,5,8,9,14], in our study, the LNR remains an independent prognostic factor for OS (OR 0.43, P < 0.01). Because, in multivariate analysis, the LNR remained independent from microscopic N2, we again recommend that the LNR should be taken in account when choosing adjuvant treatment, as previously published.…”

“…Indeed, pN2 disease represents an extremely diverse group of patients. Furthermore, several previously published case series have shown that among pN2 patients, prognosis and OS are very different according to the levels of nodal involvement (uni-or multistation), the lymph node ratio (LNR) or the presence of skip metastases [4][5][6][7]. Furthermore, it seems that according to the subtype of pN2, patients could benefit from different types of adjuvant treatment.…”

Lymph Node Ratio May Predict the Benefit of Postoperative Radiotherapy in Non–Small-Cell Lung Cancer

“…This is consistent with previous reports in NSCLC. [12][13][14][15] In contrast to most previous reports, we limited our study to patients diagnosed since 1998, after PET and integrated PET/CT was introduced into clinical practice. 18 The use of PET, and particularly integrated PET/CT, is known to result in more accurate nodal staging of NSCLC 19,20 and reduces the number of thoracotomies and futile thoracotomies.…”

“…The LNR has been shown to be prognostic in multiple malignancies, including breast cancer, 9 colon cancer, 10 and melanoma. 11 It has been shown to be prognostic in NSCLC, [12][13][14][15] but the majority of these studies have included patients diagnosed in the era before positron emission tomography (PET) or integrated PET/computer tomography (PET/CT). Furthermore, the LNR has been shown to be predictive of PORT benefit in oral cavity squamous cell carcinoma (SCC).…”

Proposal of new classification for stage III breast cancer on the number and ratio of metastatic lymph nodes

“…In particular, LNR was a more valuable prognostic factor for patients who suffer from solid malignancies. Increasing evidence suggested that lower LNR was closely relevant to improved survival for breast cancer 17–19, lung cancer 20, colon cancer 21, 22, and other carcinoma 23–26. In specifically, many studies had demonstrated that the LNR was useful in estimating prognosis and should be conjunct with the absolute number of positive lymph nodes in making the right treatment decisions for breast cancer 18, 19.…”