| Background and purposeIn recent years,lung cancer has become one of the fastest growing tumors with the highest morbidity and mortality.This can be seen from the incidence and mortality of lung cancer reported in various countries over the last 50 years[3.5.7].The incidence and mortality of lung cancer in male malignant tumors were the first,and the incidence rate of lung cancer in female malignant tumors accounted for second in the second place,and the mortality rate was only[4].At present,the etiology of lung cancer is not completely clear,a large number of survey data show that a large number of long-term smoking and lung cancer are closely related.With the development of society,the appearance of all kinds of precision instruments,the medical technology has been greatly improved.The level of diagnosis,surgical instruments,postoperative adjuvant therapy and nursing level have been greatly improved,and there is no clear contraindication and patients with stage I or II lung cancer undergo surgery,surgery（resection of the tumor lesions and source system of lymph node dissection）is the first therapy of lung cancer,especially for in non-small cell lung cancer（NSCLC）patients.As the largest category of lung cancer,the incidence and mortality of non-small cell lung cancer（NSCLC）remain high.The pathological staging of lung cancer is the key to evaluate the prognosis and to make the treatment plan.The ability to accurately assess the status of lymph node staging（N stage）in patients with non-small cell lung cancer（NSCLC）is essential for the selection of treatment and prognosis.At present,the most widely used lymph node staging system（N stage）is the International Anti Cancer Alliance Based on the lymph node region（pN stage）of the anatomical staging TNM.In recent years,with the improvement of inspection methods,the number of positive lymph nodes（MLN）and positive lymph node ratio（LNR）as the basis of the lymph node stage began to get people’s attention.Comorbid illness and adverse medical conditions due to aging is a si ficantconcern to treat elderly patients with lung cancer.Lobectomy is the current standard treatment for early-stage non-small cell lung cancer SCLC)in the general population.Sublobar resection such as wedge resection and segmentectomy could be indicated inpatients with stage I NSCLC,who may tolerate operative intervention but not a lobar orgreater lung resection because of comorbid disease or decreased cardiopulmonaryInternational Union against cancer（UICC）the latest version of the lung cancer TNM staging standards promulgated and implemented in January 2017（Table 1）,which is a major event in the field of lung cancer research and treatment in the world,this standard is an important guiding document to promote the development of a new round of lung cancer diagnosis and treatment[8].The retrospective analysis of the data from the International Lung Cancer Association（IASLC）in 81000 patients with lung cancer between 1990 and 2000 was the basis of the UICC and AJCC version of the TNM staging of lung cancer.At present,the world’s UICC seventh edition of the lung cancer TNM staging standard was promulgated in 2009,has not been revised for8 years.In the past 8 years,the great development and great progress of the research and the diagnosis and treatment of lung cancer,staging old exposed some problems,the urgent need to revise and adopt the new standards by the data from 35 databases in data from 16 countries.Including 94708 cases of lung cancer from 1999-2010.The data source in the database（90014 cases）or through electronic data collection system（EDC）submitted to the cancer research and Biostatistics（CRAB）data（4667 cases）.The revised version of the eighth edition of lung cancer staging standard was published in the 2015 issue of（Journalof Thoracic Oncology）,the research results will be the new version of the UICC standard for staging of lung cancer in early（Eighth Edition）,the main basis.Anatomical factors constitute the cornerstone of TNM staging system for lung cancer.Tumor size（tumor,T）,local lymph node involvement（node,N）and distant metastasis（metastasis,M）is a prognostic factor for characterizing the extent of histologic involvement of the disease,and may also be used to differentiate different clinical outcomes in patients with cancer.The eighth edition of non-small cell lung cancer N staging according to the regional lymph node involvement,N will be divided into four groups:no regional lymph node metastasis（NO）,ipsilateral peripheral bronchi and（or）ipsilateral hilar lymph node and lung lymph node metastasis（N1）,ipsilateral mediastinal and（or）subcarinal lymph node metastasis(（N2）,contralateral mediastinal and contralateral hilar,ipsilateral or contralateral anterior scalene muscle and supraclavicular lymph node metastasis（N3）staging,it follows the basic seventh edition of N staging system,there are no major changes in[7].However,that a large number of clinical practice,is based on anatomy and lymph node staging（pN staging）problems in the practical application stage in non-small cell lung cancer,lymph node anatomy for the same patients with different stages can exist obvious differences in prognosis,known as the heterogeneity of N staging.For the majority of malignant tumors,lymph node staging by anatomical definition and cumulative number of lymph nodes is determined,and in the latest edition of TNM staging in colon cancer,gastric cancer and esophageal cancer lymph node staging for the number of positive lymph nodes（MLN）,decision(the research shows that MLN provides for these tumors the predictive value of[5]more effective.Similarly,many studies have shown that the number of positive lymph nodes in patients with non-small cell lung cancer is also highIt is noteworthy that the number of positive lymph nodes depends on the number of lymph nodes removed and examined,and is largely affected by the surgeon and pathologist.The national comprehensive cancer network（NCCN）recommends a minimum of 6 to 10 lymph nodes or lymph nodes in non-small cell lung cancer（N）for accurate determination of lymph node（node）stage.More and more evidence that the number of positive lymph nodes（MLN）and the number of resected lymph nodes（RLN）are combined in many malignant tumor postoperative follow-up treatment has obvious implications,such as gastric cancer,colorectal cancer,thyroid cancer,breast cancer,colorectal cancer[9],so we use the positive lymph nodes rate（LNR）to describe the number of positive lymph nodes（MLN）and the number of resected lymph node（RLN）ratio,because it contains two important factors,positive lymph MethodsJanuary 20142016 years in January,683 patients in our hospital were treated with radical resection of lung cancer and regional lymph node dissection.In this study,the following conditions must be met:1.All cases were pathologically confirmed non-small cell lung cancer,lymph node metastasis after operation2.The results showed that the pathological reports were confirmed by the experienced pathologists.3.Pathological diagnosis of patients with Tis or IV stage,pathological stage according to the eighth edition of UICC/AJCC TNMDefinite diagnosis by stages"Preoperative radiotherapy and chemotherapy were excluded.4.The exclusion of a history of lung cancer or other malignant tumors,or lung cancer with tumor shuangyuanfa.Finally,a total of 480 patients were included in the retrospective study.The demographic information and clinical data were collected Pathological data.The clinical study on the positive lymph node ratio of non-small cell lung cancer Quasi pass.Clinical information and survival data.Determination of X2 value in COX risk regression model MLN,Multivariate regression analysis of prognostic factors was performed using the COX risk regression model with the optimal node of LNR.Results:1.According to the X2 value of the COX regression model,the results showed that the of the 3 lymph nodes was MLN9（LNR）MLN.is divided into 0,1-3,>3 three groups,the LNR is divided into 0%,0 a,or>35%group three.2,COX multivariate analysis identified LNR stage,smoking status,and adjuvant chemotherapy for non-small cell lung cancer Independent risk factors.3.In the literature in the multivariate analysis,LNR is related to the survival of the factor,and pN stage has significant meaning.LNR animal survival than the current pN stage forecast more meaningful4.In the literature in the multivariate analysis,LNR is higher,the lower the survival rate.Discussion:1.There are many problems in the determination of variable nodes in LNR classification.First,different surgical pathologist and between resection and lymph node number test vary greatly,so that different countries and regions and populations in the LINK value of significant heterogeneity;secondly,LNN is after operation to determine lymph node status,is not conducive to the preoperative staging and determine the treatment plan;in addition,the best classification of nodes LNR still can not reach agreement,the methods and results of selecting nodes are not the same,and the best node classification method has not been a consensus;finally,from a clinical perspective,LNR will increase the complexity of clinical staging,promotion difficult.Future research needs to focus on the uniform surgical and pathological procedures and the best classification.2.our systematic review has many limitations:all the studies are retrospective study,therefore,can not be a unified standard based in standard operation and pathology;in addition,a retrospective study of the majority of individual institutions,the number of cases is limited,relatively low level of evidence;in addition,publication bias is another a problem can not be ignored,the lack of the negative results will increase the value of the estimated bias effect.In summary,summary of our systematic review and evaluate the value of LNR in surgical resection in NSCLC prediction,although LNR is an independent prognostic factor of NSCLC,but at this stage there is not enough evidence to show that LNR can replace pN as the NSCLC lymph node staging clinical guidance,however,pN staging and LNR combination may provide the prognosis the more accurate information for patients.Conclusions1.The positive lymph node rate is an independent prognostic factor for patients with NSCLC surgery,which can be used to guide the treatment of NSCLC.The PN1should also be treated with postoperative adjuvant therapy2.This study provides the prediction direction for postoperative survival therapy for non-small-cell lung cancer patients... |
PDF Full Text Request