| Background:Lung cancer is the most common malignant tumor in our country and even in the world with morbidity and mortality in the forefront of cancers.At present,the treatment of lung cancer is gradually becoming diversified and individualized.Comprehensive treatment methods based on surgery,radiotherapy and chemotherapy,molecular targeting and immunotherapy have been recognized,but for resectable lung cancer after evaluation,the first choice is still surgical resection.For postoperative adjuvant treatment decision-making and prognosis evaluation,we pay more attention to the pathological TNM staging but less to the preoperative clinical staging.Some patients show lymph node enlargement in preoperative imaging or during operation but the postoperative pathological test is negative,that is,the postoperative stage is pN0 stage For these patients,there are no relevant studies on the causes of lymph node enlargement and the effects on prognosis,survival and distant metastasis.This study aims to explore the factors related to lymph node enlargement in patients with pN0 stage and whether clinical lymph node enlargement has reference significance for postoperative adjuvant treatment and the follow-up.Methods:The study retrospectively analyzed the clinical data of patients with lung cancer who underwent radical resection at the Department of Thoracic Surgery,Qilu Hospital of Shandong University from January 2013 to December 2015.The lymph nodes of patients need to be negative.We collect patients’ information including age,gender,preoperative lymph node size,blood routine examination,liver and kidney function indexes,pathological type,tumor size,TNM staging,number of lymph nodes to be removed and so on,then follow up the patient’s disease-free survival(DFS),overall survival(OS)and metastases situation.SPSS 22.0 was used to statistically analyze the data.According to the size of the preoperative lymph nodes,they were divided into lymph node enlargement group and non-enlarged group.Two independent sample t-test and χ2 test were used to determine the factor that affects patients’lymph node enlargement in drainage area and metastases status.Next,logistic regression analysis is used for multivariate analysis and Kaplan-Meier method to draw survival curve.Cox proportional hazards regression model is to analyze the factors affecting the prognosis and survival of patients.Results:A total of 135 pN0 patients were enrolled in our study.According to the analysis,postoperative T staging(P=0.011),total number of lymph nodes removed(P=0.036),and preoperative albumin levels(P<0.001)are related to the lymphadenopathy in drainage area.The preoperative low albumin level is independent influence factors of patients’ lymphadenopathy(OR=1.164,95%CI 1.034-1.311.P=0.012).Patients with enlarged lymph nodes have a higher recurrence rate than the control group.Lymph node enlargement in the drainage area(P=0.045)and patients,age(P=0.001),tumor T stage(P=0.027),preoperative leukocyte count(P<0.001),platelet(P=0.002),neutrophil ratio(P=0.001),and NLR(P<0.001)are all factors that affect the postoperative DFS,Tumor T stage(P=0.006),patients’ age(P<0.001),tumor location(P=0.039),preoperative leukocyte count(P=0.005),platelet count(P=0.039),neutrophil ratio(P=0.016),NLR(P<0.001)are the influencing factors of postoperative OS in lung cancer patients and age is the independent influencing factor(HR=3.79,95%CI 1.244-11.540,P=0.019).The preoperative leukocyte(P=0.016)and largest tumor diameter(P=0.018)are factors that affect the patient’s distant metastasis.Conclusion:Postoperative lymph node enlargement in the drainage area of patients with pN0 stage lung cancer is related to DFS.Patients with lymph node enlargement have a shorter DFS and the tumor recurrence rate is higher than patients without lymphadenopathy,but there is no significant effect on OS.Lymph node enlargement in preoperative imaging or intraoperative has reference significance for adjuvant treatment of pN0 patients. |
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