Establishing a Prognostic Scoring System and Exploring Prognostic Value of Examined Lymph Node Numbers for Stage I Non-small Cell Lung Cancer: a Retrospective Study of Surveillance, Epidemiology, and End Results (SEER) Database and a Chinese Cohort

Overview

Journal Transl Cancer Res

Specialty Oncology

Date 2025 Feb 20

PMID 39974421

Authors

Siyuan Wang

Xin Yin

Lingyun Wu

Hao Yu

Zhongjie Lu

Feng Zhao

Danfang Yan

Senxiang Yan

Affiliations

Soon will be listed here.

Abstract

Background: There is currently no recognized assessment system to predict disease outcomes for stage I non-small cell lung cancer (NSCLC). This research aimed to develop a prognostic scoring system for predicting 5-year overall survival (OS) of individuals with stage I NSCLC following definitive therapeutic intervention. Additionally, the optimal number of examined lymph nodes (ELNs) count for tumors no larger than 30 mm was determined.

Methods: Patients (n=22,617) diagnosed with stage I NSCLC from 2007 to 2015 who underwent definitive treatment (pulmonary lobectomy, pulmonary sublobectomy, or radiotherapy) were identified from the Surveillance, Epidemiology, and End Results (SEER) database. There were 400 Chinese patients with stage I NSCLC diagnosed in 2017 enrolled for external validation. The nomogram was constructed based on gradient boosting machine. The optimal ELNs in patients with tumors ≤30 mm and node-negative undergoing pulmonary lobectomy or pulmonary sublobectomy were determined using log-rank test and validated by multivariable analysis.

Results: Age at diagnosis, histology, differentiated grade, tumor staging, number of ELNs, and definitive treatment pattern were recognized as important factors for 5-year OS. The prognostic scoring system exhibited superior discrimination accuracy, calibration ability, and net clinical benefit compared to the tumor, node, metastasis (TNM) staging system. For patients with tumors ≤30 mm, more than 10 and 20 ELNs demonstrated the maximum OS difference during lobectomy and sublobectomy, respectively.

Conclusions: This prognostic scoring system will anticipate the prognosis of stage I NSCLC patients after radical treatment, thereby offering individualized treatment recommendations for both clinicians and patients. A minimum of 10 ELNs during lobectomy and 20 ELNs during sublobectomy are necessary for small-sized NSCLC.

References

Baumann P, Nyman J, Hoyer M, Wennberg B, Gagliardi G, Lax I . Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. J Clin Oncol. 2009; 27(20):3290-6. DOI: 10.1200/JCO.2008.21.5681. View

Bral S, Gevaert T, Linthout N, Versmessen H, Collen C, Engels B . Prospective, risk-adapted strategy of stereotactic body radiotherapy for early-stage non-small-cell lung cancer: results of a Phase II trial. Int J Radiat Oncol Biol Phys. 2010; 80(5):1343-9. DOI: 10.1016/j.ijrobp.2010.04.056. View

Darling G, Allen M, Decker P, Ballman K, Malthaner R, Inculet R . Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030.... J Thorac Cardiovasc Surg. 2011; 141(3):662-70. PMC: 5082844. DOI: 10.1016/j.jtcvs.2010.11.008. View

Wen Y, Xi K, Xi K, Zhang R, Wang G, Huang Z . The number of resected lymph nodes is associated with the long-term survival outcome in patients with T2 N0 non-small cell lung cancer. Cancer Manag Res. 2018; 10:6869-6877. PMC: 6296683. DOI: 10.2147/CMAR.S186047. View

Becker D, Levy B, Gold H, Sherman S, Makarov D, Schreiber D . Influence of Extent of Lymph Node Evaluation on Survival for Pathologically Lymph Node Negative Non-Small Cell Lung Cancer. Am J Clin Oncol. 2017; 41(8):820-825. DOI: 10.1097/COC.0000000000000379. View

Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J . Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010; 303(11):1070-6. PMC: 2907644. DOI: 10.1001/jama.2010.261. View

Osarogiagbon R, Ogbata O, Yu X . Number of lymph nodes associated with maximal reduction of long-term mortality risk in pathologic node-negative non-small cell lung cancer. Ann Thorac Surg. 2013; 97(2):385-93. PMC: 3946669. DOI: 10.1016/j.athoracsur.2013.09.058. View

CHURCHILL E, SWEET R, Soutter L, SCANNELL J . The surgical management of carcinoma of the lung; a study of the cases treated at the Massachusetts General Hospital from 1930 to 1950. J Thorac Surg. 1950; 20(3):349-65. View

Tan K, Hsu M, Adusumilli P . Pathologic node-negative lung cancer: Adequacy of lymph node yield and a tool to assess the risk of occult nodal disease. Lung Cancer. 2022; 174:60-66. PMC: 10103231. DOI: 10.1016/j.lungcan.2022.10.004. View

10.

Kubo N, Suefuji H, Nakajima M, Tokumaru S, Okano N, Yoshida D . Five-Year Survival Outcomes After Carbon-Ion Radiotherapy for Operable Stage I NSCLC: A Japanese National Registry Study (J-CROS-LUNG). J Thorac Oncol. 2023; 19(3):491-499. DOI: 10.1016/j.jtho.2023.10.016. View

11.

Licht P, Jorgensen O, Ladegaard L, Jakobsen E . A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer. Ann Thorac Surg. 2013; 96(3):943-9. DOI: 10.1016/j.athoracsur.2013.04.011. View

12.

Jiang H, Wu T, Qie P, Wang H, Zhang B . Comparative analysis of the clinical effects of different thoracoscopic resection in the treatment of Stage I Non-Small Cell Lung Cancer. Pak J Med Sci. 2024; 40(8):1644-1650. PMC: 11395368. DOI: 10.12669/pjms.40.8.9124. View

13.

Stiles B, Servais E, Lee P, Port J, Paul S, Altorki N . Point: Clinical stage IA non-small cell lung cancer determined by computed tomography and positron emission tomography is frequently not pathologic IA non-small cell lung cancer: the problem of understaging. J Thorac Cardiovasc Surg. 2009; 137(1):13-9. DOI: 10.1016/j.jtcvs.2008.09.045. View

14.

Koike T, Yamato Y, Yoshiya K, Shimoyama T, Suzuki R . Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg. 2003; 125(4):924-8. DOI: 10.1067/mtc.2003.156. View

15.

Li C, Liu J, Lin J, Li Z, Shang X, Wang H . Poor survival of non-small-cell lung cancer patients with main bronchus tumor: a large population-based study. Future Oncol. 2019; 15(24):2819-2827. DOI: 10.2217/fon-2019-0098. View

16.

Quero-Valenzuela F, Piedra-Fernandez I, Hernandez-Escobar F, Martinez-Ceres M, Romero-Palacios P, De Guevara A . Half the deaths after surgery for lung cancer occur after discharge. Surg Oncol. 2018; 27(4):630-634. DOI: 10.1016/j.suronc.2018.07.017. View

17.

Gallina F, Marinelli D, Taje R, Forcella D, Alessandrini G, Cecere F . Analysis of predictive factors of unforeseen nodal metastases in resected clinical stage I NSCLC. Front Oncol. 2023; 13:1229939. PMC: 10661928. DOI: 10.3389/fonc.2023.1229939. View

18.

Rowell N, Williams C . Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable). Cochrane Database Syst Rev. 2001; (1):CD002935. DOI: 10.1002/14651858.CD002935. View

19.

Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D . Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023; 388(6):489-498. PMC: 10036605. DOI: 10.1056/NEJMoa2212083. View

20.

Rami-Porta R, Tsuboi M . Sublobar resection for lung cancer. Eur Respir J. 2009; 33(2):426-35. DOI: 10.1183/09031936.00099808. View