Prognostic Value of Lymph Node Ratio (LNR) in Patients with Postoperative N2 Feature in Non-Small Cell Lung Cancer (NSCLC)

Abstract

Introduction: One of the most important prognostic factors in non-small cell lung cancer (NSCLC), a condition with a high mortality rate, is the presence of mediastinal lymph node metastases alongside distant metastases. The aim of this study was to evaluate the prognostic value of selected parameters of N2 stage NSCLC with a special focus on lymph node ratio (LNR). Material: The study included 163 patients (61 women and 102 men) operated on due to NSCLC, postoperatively diagnosed as stage N2. The age of the patients ranged from 38 to 82 years (mean age: 62.4 years). The effects of the following factors on clinical data and survival rate were assessed: N1 stage, total number of all metastatic nodes, LNR and LNR N2 ratios, and the presence of skip, single- or multistation metastases. Results: Univariate analysis showed patient survival to be correlated with LNR and LNR N2 ratios, single/multistation metastases, and the number of nodes involved in metastasis. A multivariate model based on patient clinical data found nicotine dependence (p = 0.013), LNR > 0.26 (p = 0.004), and Charlson Comorbidity Index (CCI) value > 3 (p = 0.014) to be independent adverse prognostic factors in this group. Conclusions: LNR ratio is a significant cancer disease-derived independent prognostic factor for patients with postoperative N2 stage NSCLC. In addition, smoking and comorbidities also appear to have prognostic value.