临床肿瘤学杂志

目的 探讨阳性淋巴结对数比值比(LN-LOR)预测接受新辅助放化疗和手术的局部进展期非小细胞肺癌(NSCLC)患者预后的价值。方法 回顾性收集2020年3月至2021年12月间在邯郸市第一医院接受新辅助放化疗和手术治疗的185例局部进展期NSCLC患者的临床病历资料。LN-LOR定义为清扫淋巴结时阳性淋巴结与阴性淋巴结之比的对数，计算公式为log[(阳性LN+0.5)/(清扫LN-阳性LN+0.5)]。随访患者总生存期(OS)、无疾病生存期(DFS)和局部区域复发(LRR)时间。结果 LN-LOR中位值为-0.20(-1.41～1.67)。根据中位值分为LN-LOR低危组和LN-LOR高危组。LN-LOR高危组pN分期以及受累淋巴结站数和淋巴结比值较高，而且第7站LN阳性的患者往往更常出现在LN-LOR高危组中(P<0.05)。患者中位随访时间为36(9.93～36)个月，85例死亡，99例进展者，52例局部复发。死亡患者治疗前LN-LOR显著高于存活患者[-0.10(-0.36,0.21)vs.-0.35(-0.50,-0.16),Z=-2.904,P=0.004];进展和局部复发者LN-LOR也显著高于无进展[-0.10(-0.35,0.21)vs.-0.28(-0.49,-0.13),Z=-3.126,P=0.002]和无局部复发者[-0.11(-0.35,0.30)vs.-0.29(-0.52,-0.11),Z=-2.597,P=0.009]。Cox风险比例回归模型分析显示，LN-LOR≥-0.20是影响局部进展期NSCLC患者OS、DFS和LRR的独立危险因素(P<0.05)。与LN-LOR低危组比较，LN-LOR高危组患者中位OS更短(36个月vs. 31个月，Log rankχ²=10.519,P=0.001);中位DFS(31个月vs. 14.29个月，Log rankχ²=14.473,P<0.001)和中位无LRR时间(32个月vs. 18.66个月，Log rankχ²=13.440,P<0.001)也明显缩短。LN-LOR高危组中，ypN_1-2期患者中位OS、DFS和无LRR时间也显著短于ypN_0/X期患者(P<0.05)。结论 LN-LOR与局部进展期NSCLC患者的预后显著相关，可以更好地反映LN负担和疾病的生物学行为。

Objective To explore the value of positive lymph node logarithmic ratio(LN-LOR) in predicting the prognosis of patients with locally advanced non-small cell lung cancer(NSCLC) who receive neoadjuvant chemoradiotherapy and surgery. Methods The clinical medical records of 185 patients with locally advanced NSCLC who received neoadjuvant chemoradiotherapy and surgical treatment at Handan First Hospital from March 2020 to December 2021 were retrospectively collected. Ln-lor is defined as the logarithm of the ratio of positive lymph nodes to negative lymph nodes during lymph node dissection, and the calculation formula is log[(positive LN+0.5)/(dissected LN-positive LN+0.5)]. The overall survival(OS), disease-free survival(DFS) and local regional recurrence(LRR) of the patients were followed up. Results The median value of LN-LOR was-0.20(-1.41 to 1.67). According to the median value, they were divided into the low-risk LN-LOR group and the high-risk LN-LOR group. The pN stage, the number of involved lymph node stations and the lymph node ratio were higher in the high-risk LN-LOR group. Moreover, patients with positive LN at the 7th station tended to occur more frequently in the high-risk LN-LOR group(P<0.05). The median follow-up time of the patients was 36(9.93-36) months. There were 85 deaths, 99 cases of progression, and 52 cases of local recurrence. Before treatment, LN-LOR in deceased patients was significantly higher than that in surviving patients [-0.10(-0.36, 0.21) vs.-0.35(-0.50,-0.16), Z=-2.904, P=0.004]; The LN-LOR in patients with progression and local recurrence was also significantly higher than that in patients without progression [-0.10(-0.35, 0.21) vs.-0.28(-0.49,-0.13), Z=-3.126, P=0.002] and those without local recurrence [-0.11(-0.35, 0.30) vs.-0.29(-0.52,-0.11), Z=-2.597, P=0.009]. Analysis by the Cox proportional hazards regression model showed that LN-LOR≥-0.20 was an independent risk factor affecting OS, DFS and LRR in patients with locally advanced NSCLC(P<0.05). Compared with the low-risk LN-LOR group, the median OS of patients in the high-risk LN-LOR group was shorter(36 months vs. 31 months, Log rank χ²=10.519, P=0.001); The median DFS(31 months vs. 14.29 months, Log rank χ²=14.473, P<0.001) and the median no-LRR(32 months vs. 18.66 months, Log rank χ²=13.440, P<0.001) were also significantly shortened. In the high-risk group of LN-LOR, the median OS, DFS and non-LRR of patients in ypN_1-2 stage were also significantly shorter than those of patients in ypN_0/X stage(P<0.05). Conclusion LN-LOR is significantly correlated with the prognosis of patients with locally advanced NSCLC and can better reflect the burden of LN and the biological behavior of the disease.