Non- indicator strategies for n1. Introduction


Background: Non-small cell lung cancer NSCLC patients with N1 disease have variable outcomes, and additional prognostic factors are needed.

Prognostic factor and treatment strategy for clinical N1 non-small cell lung cancer.

The number of positive lymph nodes LNs has been proposed as a prognostic indicator. However, the number of positive LNs depends on the number of LNs examined from the resection specimen. The lymph node ratio LNR can circumvent this limitation. We also evaluated heterogeneity and publication bias.

Results: Five studies published between and were eligible for this systematic review with meta-analysis. The total number of patients included was 6, ranging from 75 non- indicator strategies for n1 4, patients per study. We found no heterogeneity and publication bias between the reports. Accepted for publication Jun 28, Only a fraction of NSCLC patients are non- indicator strategies for n1 with localized, early-stage disease, when curative-intent surgical resection is possible 23.

After surgery, the status of regional lymph node LN involvement is the most important prognostic factor 4. Pathologic nodal involvement pN connotes a poor prognosis, but also predicts the likelihood non- indicator strategies for n1 benefit from postoperative adjuvant therapy. Multiple investigators have demonstrated the heterogeneity in survival of patients with pN0 resections, suggesting the possibility that a significant proportion of these patients are understated, probably because LN metastasis is missed 5 - 8.

non- indicator strategies for n1

These results suggest a need to identify patterns of LN involvement that more accurately predict survival, particularly of patients with N1 disease 10 Because the thoroughness of nodal examination interacts with the likelihood of detecting nodal metastasis, the number of positive LNs may depend on by the number of LNs examined from the resection specimen.

Therefore, the prognostic accuracy of the actual number of positive LNs is potentially restricted The lymph node ratio LNR —the number of positive LNs divided by the number of LNs examined- has been suggested to be a more accurate prognostic indicator than the number of LNs with metastasis in different types of cancer including thyroid, gastric, colorectal, and cancer 13 - References cited in the identified publications were also used to complete the search.

non- indicator strategies for n1

Inclusion criteria Two of the authors Qian Li, Ping Zhan independently determined the eligibility of the studies retrieved from the databases and bibliographies Figure 1. Studies eligible for inclusion in this meta-analysis met the following criteria: include early stage NSCLC patients who underwent surgical resection; include the patients harboring pathological N1 disease; provide information on survival studies investigating response rates only were excluded ; have a follow-up time not less than two years; and for multiple publications reporting on the same patient population, only the most recent, or the most complete, report was included.

Non- indicator strategies for n1 among reviewers was resolved by mutual agreement after further discussion. Figure 1 Flow chart representing the process of literature search and study selection. Exclusion criteria Publications were excluded if they met any of the following criteria: I case series, case reports, reviews and conference reports; II duplicate publications; III studies based on overlapping cohorts from the same institution. Given the variability in the quality of cohort studies found in our initial literature search, we considered studies to be of high quality if they achieved a score of six or more on the Newcastle-Ottawa Scale.

Data retrieved from the reports included first author, year of publication, country, lung cancer stage, number of patients, time, and survival data Table 1. Table 1 Clinical and methodological characteristics of included studies Full table Definition of outcomes The primary outcome was overall survival OSmeasured from the date of surgery to the date of death or date of last follow-up; the secondary outcome was disease-free survival DFSmeasured from the date of surgery to the date of disease progression or date non- indicator strategies for n1 last follow-up.

Heterogeneity test with I2 statistic was performed. Individual meta-analysis was conducted in each subgroup. If HRs were found to have acceptable homogeneity, a fixed effect model was used for secondary analysis; if not, a random effect model was used. The HR point estimate was reflected in each box and the box area is proportional to the weight of the study.

The diamond and broken line represents the overall summary estimate, with CI represented by its width.

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  • Prognostic factor and treatment strategy for clinical N1 non-small cell lung cancer. - ClinOwl
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Existence of publication bias was evaluated by the methods of Begg et al. Moreover, a contour-enhanced funnel plot was performed to aid in interpreting the funnel plot Publication bias can lead to the asymmetry that studies appear to be missing in areas of low statistical significance, while it is less likely to cause non- indicator strategies for n1 funnel asymmetry under the circumstance of studies missing in areas of high statistical significance.

Intercept significance was determined by the t-test suggested by Egger Results Study selection and characteristics Five studies published between and were eligible for this systematic review with meta-analysis 26 - The total number of patients included was 6, ranging from 75 to 4, patients per study.

The major characteristics of the five non- indicator strategies for n1 publications are reported in Table 1. Meta-analysis The results of the meta-analysis are reported in Figures 23 and 4.

non- indicator strategies for n1

Each box represents the OR point estimate, and its area is proportional to the weight of the study. Furthermore, according to the contour-enhanced funnel plot Figure 4no evidence of publication bias was found in all five studies.

The LNR has been shown to be an important prognostic factor in several malignancies 13 - 19 and may overcome the limitation in the number of LNs sampled. Consistent with this notion Bria et al.

non- indicator strategies for n1

The higher LNR, the worse the prognosis. However, patients with pathologic N1 disease have heterogeneous outcomes 49 Some have proposed that this survival heterogeneity is partly driven by heterogeneity in staging accuracy caused by heterogeneity in the thoroughness of hilar and intrapulmonary LN retrieval 33 - The value of the LNR may be in partially adjusting for this heterogeneity in thoroughness of nodal evaluation.

Current guidelines on lung cancer surgery do not specify the number of LNs that should be sampled for adequate staging. Several large population-based studies have suggested that more than ten LNs should be examined in the resection specimens of patients categorized as pathologic node-negative 5 - 8.

There has been less emphasis on the need for thorough N1 nodal examination in patients with pN1 disease.

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However, the burden of metastatic disease, reflected by the number or proportion of LNs with metastasis, may have great prognostic significance. The total number of N1 nodes detected with metastasis is, theoretically, limited by the total number of LNs examined. Our results support using the LNR as an independent means of risk-stratifying patients with pN1, and potentially identifying patients who might benefit from more intense postoperative adjuvant therapy, might need closer surveillance, or might be targeted for enrollment into clinical trials of novel adjuvant therapies.

Potential limitations of our study include the limitation to articles published in the English language, the possibility of a publication bias, since we could not include studies that may not have been published because of negative results, and the small number of eligible studies in this meta-analysis.

The LNR should be considered in determining post-operative management of patients with pN1, because it provides a more accurate assessment of prognosis. Acknowledgements We apologize to all researchers whose relevant contributions were not cited due to space limitations.

Abstract Background: Early detection of non-small-cell lung cancer NSCLC and accurate prognostic risk assessment could improve patient outcome. An increased urinary DASr value was significantly associated with pathological stage, other histological invasive factors and unfavourable outcomes in patients with completely resected NSCLC. The DASr could be a useful biomarker for detecting malignancies and predicting prognosis. Keywords: tumour marker, prognostic indicator, urine diacetylspermine, non-small-cell lung cancer Non-small-cell lung cancer NSCLC is the most common cause of cancer deaths and is a challenging clinical problem globally, with an increasing incidence and mortality in both developing and developed countries Wang et al, ; Jemal et al, a.

Footnote Conflicts of Interest: The authors have no conflicts reviews about binomo option interest to declare. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev ; Cancer statistics, CA Cancer J Clin ; J Thorac Oncol ; Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer.

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Chest ; Extent of lymphadenectomy and outcome for patients with stage I nonsmall cell lung cancer. Cancer ; Prognostic significance of the number of lymph nodes removed at lobectomy in stage IA non-small cell lung cancer.

non- indicator strategies for n1

Number of lymph nodes associated with maximal reduction of long-term mortality risk in pathologic node-negative non-small cell lung cancer. Ann Thorac Surg ; Local recurrence after surgery for early stage lung cancer: an year experience with patients.

Louis, St. Email: moc. Received May 17; Accepted Jun Copyright Translational Lung Cancer Research.

Pathologic N1 non-small cell lung cancer: correlation between pattern of lymphatic spread and prognosis. J Thorac Cardiovasc Surg ;

non- indicator strategies for n1