ArticleTranslational lung cancer research2022
A new N descriptor for non-small cell lung cancer: the classification based on anatomic location, number and ratio of metastatic lymph nodes.
Article in Translational lung cancer research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed.
- N1 Staging in Non-Small Cell Lung Cancer: Current Situation, Limitations, and the Importance of Peripheral Nodal Assessment.Cancers · 2026Review
- N-LODDS: A Novel Integrated Lymph Node Staging System Enhancing Prognostic Accuracy in Non-Small-Cell Lung Cancer.Annals of surgical oncology · 2026Article
- Survival impact of pN2a and pN2b nodal status in stage IIB-IIIB non-small cell lung cancer under the 9Turk gogus kalp damar cerrahisi dergisi · 2026Article
- Is It Time to (Re)define the N-Category for Metastatic Lymph Nodes in Non-Small Cell Lung Cancer?The clinical respiratory journal · 2024Article
- Association between radiotherapy and risk of second primary malignancies in patients with resectable lung cancer: a population-based study.Journal of translational medicine · 2023Article
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Abstract
Background: The current N classification, which is determined by the anatomical location of positive lymph nodes, does not effectively stratify N1 and N2 non-small cell lung cancer (NSCLC) patients into prognostically significant subgroups. Methods: We acquired the clinical data of 3,234 N1 and N2 NSCLC patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). We eliminated patients undergoing chemotherapy or radiation because chemotherapy and radiotherapy might lower lymph node stage, and the SEER database does not distinguish between therapy administered before and after surgery. We developed the N-new classification based on the former N stage, the number and ratio of lymph nodes. Patients were finally classified into four categories (N1a, N1b, N2a, N2b). Then, the N-new classification was validated in subgroups based on a variety of clinical characteristics, such as tumor size. The multivariable Cox regression analysis, the decision curve analysis (DCA) and the time-dependent receiver operating characteristic (ROC) analysis were conducted to compare the performance of the N-new classification and the current N classification. Results: The cancer-specific survival (CSS) and overall survival were significantly different among each pair of N-new classification. And the same results were shown in the majority of the subgroups determined by various clinical characteristics. Compared with the current N classification (C-index, 0.639), the N-new classification (C-index, 0.652) performed better in classifying N1 and N2 NSCLC patients into subgroups with distinctive clinical outcomes. The 5-year CSS rates were 49.7%, 41.4%, 30.4% and 20.4% for N1a, N1b, N2a and N2b, respectively. Conclusions: When compared to the current N classification, the N-new classification could be a more reliable and accurate prognostic determinant, which is worth considering in the revision of the 9th edition of the tumor, node, metastasis (TNM) staging system.
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