Prognostic value of number of negative lymph node in patients with stage II and IIIa non-small cell lung cancer

Effect of the number of negative lymph nodes removed on the survival and recurrence rate patients with non-small-cell lung cancer undergoing surgery: A multicenter retrospective cohort study

The role of the number of negative lymph nodes (NLNs) removed on survival and tumor recurrence after surgery in patients with non-small-cell lung cancer (NSCLC) is still unclear. This study aimed to evaluate the effect of the number of NLNs on overall survival (OS), recurrence-free survival (RFS), and recurrence rate of patients with NSCLC after surgery. This multicenter retrospective cohort study examined the medical profile of 1002 patients with a definite diagnosis of NSCLC who underwent surgery between 2021 and 2023 at one of our medical centers. Patients with NSCLC were classified into 4 groups based on the number of NLNs removed during surgery as follows. I: <10 (196 patients); II: 10 to 19 (341 patients); III: 20 to 30 (267 patients); and IV: >30 NLN (198 patients). The patients' demographics, tumor characteristics, and pathological findings were obtained by reviewing their medical records. The 5-year survival rate was 36.1%. The OS rate in groups I, II, III, and IV patients was 14%, 25%, 33%, and 43%, respectively (log-rank = 161.2, P = .001). Also, the RFS rate in patients of groups V/III was significantly higher than in groups I/II (P < .05). Multivariate analysis showed that the OS rate in group V and II patients was significantly higher than the other 2 groups (I and II). In addition, age > 65 years, comorbidity, tumor size > 3, advanced tumor stage, presence of metastasis, lymph node ratio > 0.3, total lobectomy, central tumor, and no adjuvant chemotherapy are significantly associated with decreased OS rate of patients with NSCLC. The increase in the number of NLNs removed during surgery was associated with an increase in the OS and RFS rates. Attention to this number can be a key factor in improving the survival prediction of patients with NSCLC.

Prognostic Relevance of Negative Lymph Node Count in Resected Stage I-IIIa Small-cell Lung Cancer

OBJECTIVES

The prognostic significance of the negative lymph node (NLN) count has been confirmed in various cancers but not in small-cell lung cancer (SCLC). We aimed to evaluate the correlation between the NLN count and the prognosis of patients with stages I-IIIa SCLC who underwent lobectomy.

METHODS

Data on the clinical characteristics of SCLC patients who underwent lobectomy between 2000 and 2019 were collected from the SEER database and organized based on the X-tile plots to identify the optimal cutoff point for the NLN count. Kaplan-Meier curves and a Cox proportional hazard model were used to evaluate the prognostic factors for overall survival (OS) and lung cancer-specific survival.

RESULTS

Based on the X-tile plot-determined cutoff points of 3 and 7, the participants were grouped into the low (<3), middle (3-7), and high (>7) NLN subgroups for the analysis of OS. Univariable analysis showed that a higher NLN count correlated with more favorable OS and lung cancer-specific survival (both P <0.001). Multivariate analysis demonstrated that, after adjustment for related factors, the NLN count was positively associated with the prognosis and might thus be an independent risk factor for prognosis. Subgroup analyses revealed that, among different LN statuses and varied positive LN counts, the NLN count could predict the prognosis independently.

CONCLUSIONS

Higher NLNs correlated with better survival for patients who underwent lobectomy of stages I-IIIa SCLC. A predictive marker that combines the NLN count with the N stage and positive LN count could provide more prognostic information in SCLC.

Establishment and Validation of a Nomogram Based on Negative Lymph Nodes to Predict Survival in Postoperative Patients with non-Small Cell Lung Cancer

Background: The importance of the negative lymph node (NLN) count has recently attracted attention. This study aimed to determine the prognostic value of NLN count in patients with non-small cell lung cancer (NSCLC) after radical surgery by constructing NLN-based prognostic models. Methods: This study included 33 756 patients pooled from the case listing session of the US Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 and 545 patients collected from The First Affiliated Hospital of Shandong First Medical University between 2012 and 2016. X-tile software was used to calculate the optimal cutoff value for the NLN count. The associated clinical factors were determined using univariate and multivariate Cox analyses. Nomograms were developed using the SEER database and validated using hospital data. Results: The training cohort was divided into high and low NLN count subgroups based on the cancer-specific survival (CSS) and overall survival (OS), respectively. Multivariate analysis showed that NLN count was an independent prognostic factor, and the high NLN count subgroup had better CSS and OS than those of the low NLN count subgroup (HR = 0.632, 95% CI 0.551-0.724, P < .001 for CSS and HR = 0.641, 95% CI 0.571-0.720, P < .001 for OS). Nomograms were established, exhibiting good discrimination ability with a C-index of 0.789 (95% CI 0.778 −0.798) for CSS and 0.704 (95% CI, 0.694 −0.714) for OS. The calibration plots of the validation cohorts showed optimal agreement with the training cohort, with a C-index of 0.681 (95% CI 0.646 −0.716) for CSS and 0.645 (95% CI 0.614 −0.676) for OS. Conclusions: NLN count is a strong prognostic factor for OS and CSS in NSCLC patients and the prognostic model provides a useful risk stratification for NSCLC patients when applied to clinical practice.

The H3K4 methyltransferase SETD1A is required for proliferation of non-small cell lung cancer cells by promoting S-phase progression

Epigenetic dysregulation has been strongly implicated in carcinogenesis and is one of the mechanisms that contribute to the development of lung cancer. Using genome-wide CRISPR/Cas9 library screening, we showed SET domain-containing protein 1A (SETD1A) is an essential epigenetic modifier of the proliferation of NSCLC H1299 cells. Depletion of SETD1A strikingly inhibited the proliferation of NSCLC cells. IHC staining and bioinformatics showed that SETD1A is upregulated in lung cancer. Kaplan-Meier survival analysis indicated that high expression of SETD1A is associated with poor prognosis of patients with NSCLC. We revealed that loss of SETD1A inhibits DNA replication and induces replication stress accompanied by impaired fork progression. In addition, transcription of CDC7 and TOP1, which are involved in replication origin activation and fork progression, respectively, was significantly reduced by knockdown of SETD1A. Taken together, these findings demonstrated SETD1A is a critical epigenetic modifier of NSCLC cell proliferation by promoting the transcription of a subset of DNA replication-associated genes.

Ratio between negative and positive lymph nodes is a novel prognostic indicator for patients with esophageal cancer: A Surveillance, Epidemiology and End Results database analysis

Background

The aim of this study was to explore whether the ratio between negative and positive lymph nodes (R_NP) could predict the overall survival (OS) of esophageal cancer (EC) patients with lymph node metastasis following esophagectomy.

Methods

We utilized the Surveillance, Epidemiology and End Results (SEER) database to include the records of 2374 patients with lymph node metastases post‐surgery. All patients were randomly assigned into the training cohort (n = 1424) and validation cohort (n = 950). Multivariate Cox regression analyses were performed to identify independent prognostic factors. A novel R_NP ‐based TR_NPM staging system was proposed. The prognostic value of N, R_NP, TNM and TR_NPM staging system was evaluated using the linear trend χ² test, likelihood ratio χ² test, and Akaike information criterion (AIC) to determine the potential superiorities. We constructed nomograms to predict survival in both cohorts, and the calibration curves confirmed the predictive ability.

Results

Univariate analyses showed that N and R_NP stage significantly influenced the OS of patients. Multivariate analyses revealed that R_NP was an independent prognostic predictor in both the training and validation cohorts. For the stratification analysis in the two cohorts, we found significant differences in the prognosis of patients in different R_NP groups on the basis of the different N stages and the number of dissected lymph nodes. In addition, the lower AIC value of R_NP stage and TR_NPM staging system represented superior predictive accuracy for OS than the N stage and TNM staging system, respectively. Furthermore, the calibration curves for the probability of three‐ and five‐year survival showed good consistency between nomogram predictive abilities and actual observation.

Conclusions

We demonstrated that compared to the classical pathological lymph nodal staging system, the R_NP stage showed superior predictive accuracy for OS and can serve as a more effective prognostic guidance for lymph node positive EC patients.

Alternative methods of lymph node staging in lung cancer: a narrative review

The nodal status indicator in non-small cell lung cancer is one of the most crucial prognostic factors available. However, there are still many arguments among scientists regarding whether the currently used nodal status descriptor should be changed in the forthcoming editions of the Tumor Node Metastasis classification or whether it is precise enough and should be maintained as is. We reviewed studies concerning nodal factor classifications to evaluate their accuracy in non-small cell lung cancer patients and to address the previously mentioned challenge. We reviewed the PubMed database regarding the following classifications: ongoing 8^th edition of the Tumor Node Metastasis classification, number of positive lymph nodes, number of negative lymph nodes, number of dissected lymph nodes, lymph node ratio, nodal chains, log odds of positive lymph nodes, zone-based classification and one that is based on the number of lymph node stations involved. Moreover, we analysed data regarding various combinations of these classifications. Our analysis showed that the present nodal staging may not accurately categorize every lung cancer patient. The number of positive lymph nodes and lymph node ratio or the log odds of positive lymph nodes (as the mathematical modification of lymph node ratio) are more legitimate, as they possess very robust data and should be considered initially as additional factors that can be incorporated in ongoing nodal staging systems. Forthcoming non-small cell lung cancer staging systems could benefit from the addition of quantitative-based parameters. Additionally, the minimal extent of lymphadenectomy should be established as staging benefits from it. International, prospective validation studies need to be performed to optimize the cut-off values and prognostic groups and to confirm the superiority of the newly suggested descriptors in non-small cell lung cancer nodal staging.

Negative Lymph Node Count Predicts Survival of Resected Non-small Cell Lung Cancer

PURPOSE

The purpose of this study was to explore the association between the negative lymph node (NLN) count and survival, as well as compare the prognostic value of the positive lymph node (PLN) count, lymph node ratio (the PLN count/total lymph nodes examined, LNR), and NLN count in patients with non-small cell lung cancer (NSCLC).

METHODS

We identified patients diagnosed with NSCLC between 2005 and 2011 from the Surveillance, Epidemiology, and End Results database. Outcomes of interest were lung cancer-specific survival (LCSS) and overall survival (OS). Cases were divided into several groups based on the PLN count, NLN count, and LNR. The prognostic significance of the PLN count, NLN count, and LNR models was analyzed with the Kaplan-Meier method and the Cox regression model.

RESULTS

39,959 patients with surgical resection for NSCLC were identified. Univariate analysis demonstrated that a greater count of NLNs was associated with better LCSS (P < 0.001) and OS (P < 0.001). Subgroup analysis showed that the NLN count could predict survival in both node-negative and node-positive patients. Multivariable analysis revealed that the NLN count was an independent prognostic factor for LCSS and OS.

CONCLUSION

The NLN count is an independent prognostic factor of OS and LCSS in patients with NSCLC, as well as the PLN count and LNR. The prognostic value of the PLN count, NLN count, and LNR shows no difference.

Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis

BACKGROUND

This meta-analysis aimed to investigate the prognostic value of lymph node ratio in non-small-cell lung cancer.

METHODS

We searched systematically for eligible studies in PubMed, Web of Science, Medline (via Ovid) and Cochrane library through 6 November 2018. The primary outcome was overall survival. Disease-free survival and cancer-specific survival were considered as secondary outcomes. Hazard ratio with corresponding 95% confidence interval were pooled. Quality assessment of included studies was conducted. Subgroup analyses were performed based on N descriptors, types of tumor resection, types of lymphadenectomy and study areas. Sensitivity analysis and evaluation of publication bias were also performed.

RESULTS

Altogether, 20 cohorts enrolling 76 929 patients were included. Mean Newcastle-Ottawa Scale was 7.65 ± 0.59, indicating the studies' quality was high. The overall result showed non-small-cell lung cancer patients with lower lymph node ratio was associated with better overall survival (HR: 1.946; 95% CI: 1.746-2.169; P < 0.001), disease-free survival (HR: 2.058; 95% CI: 1.717-2.467; P < 0.001) and cancer-specific survival (HR: 2.149; 95% CI: 1.864-2.477; P < 0.001). Subgroup analysis prompted types of lymphadenectomy and the station of positive lymph node have an important effect on the prognosis. No significant discovery was found in sensitivity analysis.

CONCLUSION

Patients with lower lymph node ratio was associated with better survival, indicating that lymph node ratio may be a promising prognostic predictor in non-small-cell lung cancer. The type of lymphadenectomy, an adequate examined number and the removed stations should be considered for more accurate prognosis assessment.

miR‑671‑3p is downregulated in non‑small cell lung cancer and inhibits cancer progression by directly targeting CCND2

MicroRNAs (miRNAs) are implicated in the development and progression of non‑small cell lung cancer (NSCLC). A previous study suggested that miR‑671‑3p suppresses the development of breast cancer. However, the role of miR‑671‑3p in NSCLC remains largely unknown. In the present study, it was identified that miR‑671‑3p was significantly upregulated in NSCLC tissues compared with adjacent normal tissues by reverse transcription quantitative polymerase chain reaction (RT‑qPCR). Similarly, decreased levels of miR‑671‑3p in NSCLC cell lines were observed compared with those in the non‑tumorigenic human bronchial epithelial NL20 cell line. Cell Counting Kit‑8 and Transwell invasion assays indicated that miR‑671‑3p overexpression suppressed the proliferation and invasion of A549 cells, and vice versa. Mechanistically, it was demonstrated that CCND2 was a direct target of miR‑671‑3p. RT‑qPCR and western blot analysis indicated that miR‑671‑3p overexpression decreased the expression of CCND2 in A549 cells. Furthermore, rescue experiments demonstrated that the restoration of CCND2 may significantly reverse the suppressive roles of miR‑671‑3p overexpression on NSCLC cell proliferation and invasion. Taken together, the present study demonstrated that miR‑671‑3p exerted its tumor‑suppressive roles via directly targeting CCND2 in NSCLC.

MicroRNA-214 inhibits the proliferation and invasion of lung carcinoma cells by targeting JAK1

Increasing evidence suggests that microRNAs (miRNAs) play a crucial role in the pathogenesis of tumor. In this study, miR-214 was found to be significantly down-regulated in lung tumor tissues and lung cell lines. From the gain-of-function experiment results, we found that ectopic expression of miR-214 in lung cancer cell lines significantly inhibited cell growth, as evidenced by cell viability and colony formation assays, and suppressed tumor growth in vivo. Besides, further investigations showed that miR-214 inhibited cell migration and invasion. The luciferase activity assay revealed that oncogene Janus kinase 1 (JAK1) was a direct target gene of miR-214, and its expression was inversely correlated with that of miR-214. Altogether, our findings demonstrated that miR-214 plays a pivotal role in lung cancer by inhibiting cell proliferation, invasion and migration by targeting oncogenic JAK1, and thus, miR-214 may provide a new potential therapeutic target in lung cancer.

miR-1269 promotes cell survival and proliferation by targeting tp53 and caspase-9 in lung cancer

Background and aim

Lung cancer is the leading cause of cancer death worldwide. In this study, we aim to elucidate the role of miR-1269 in the pathogenesis of lung cancer.

Methods and results

From the results of analyses using The Cancer Genome Atlas (TCGA) database, we noted the expression of miR-1269 was increased in lung cancer tissue. miR-1269 expression was detected in both the normal adjacent lung tissue and in the tumorous lung tissue of lung cancer patients, and miR-1269 was more highly expressed in the tumors. High expression of miR-1269 correlated with patients’ tumor stage and lymph node metastasis. A Cell Counting Kit-8 (CCK8) analysis and a cloning formation assay showed that overexpression of miR-1269 significantly promoted the growth of A549 cells, and that a lower expression of miR-1269 significantly increased cell apoptosis. We used the TargetScan 6.2 Database to predict the potential targets of miR-1269, and a luciferase activity assay was used to determine the direct interaction between miR-1269, tumor protein p53 (TP53), and caspase-9. Results from Western blots and real-time PCR showed that overexpression of miR-1269 significantly inhibited TP53 and caspase-9 expression. In addition, caspase-3 activity was found to decrease in a miR-1269 mimic group. The results showed that gene silencing of TP53 and caspase-9 significantly inhibited A549 cell growth and promoted cell apoptosis. The results also showed that the inhibition of miR-1269 and caspase-9 expression inhibited cell apoptosis. Immunohistochemistry (IHC) results demonstrated that TP53 and caspase-9 were expressed in low levels in tumor tissues, and that an inverse correlation exists between miR-1269 expression levels and TP53 or caspase-9 expression levels.

Conclusion

These results demonstrate that miR-1269 promotes cell survival and proliferation by targeting TP53 and caspase-9 in lung cancer.

Epidermal growth factor receptor expression affects proliferation and apoptosis in non-small cell lung cancer cells via the extracellular signal-regulated kinase/microRNA 200a signaling pathway

The present study assessed the function of epidermal growth factor receptor (EGFR) and its molecular targets in non-small cell lung cancer. The results of the present study demonstrated that EGFR protein and mRNA expression in the normal adjacent tissue specimens was decreased compared with that in the lung cancer tissue samples. Compared with the BEAS-2B normal bronchial epithelial cells, EGFR and phosphorylated (p)-extracellular signal-regulated kinase (ERK) protein expression in the SW-900 and A549 lung cancer cells was increased and microRNA (miR)200a expression in the SW-900 and A549 cells was inhibited compared with the BEAS-2B cells. Downregulating miR200a expression significantly suppressed proliferation and promoted apoptosis and caspase (CASP)3 and CASP9 function in the A549 cells and significantly inhibited EGFR and p-ERK protein expression in the A549 cells, compared with the BEAS-2B cells. The results of the present study indicated that downregulating miR200a significantly suppressed proliferation and promoted apoptosis in A549 cells via the regulation of the EGFR and ERK 1/2 signaling pathways.

A nomogram to predict the survival of stage IIIA-N2 non-small cell lung cancer after surgery

OBJECTIVE

Postoperative survival of patients with stage IIIA-N2 non-small cell lung cancer (NSCLC) is highly heterogeneous. Here, we aimed to identify variables associated with postoperative survival and develop a tool for survival prediction.

METHODS

A retrospective review was performed in the Surveillance, Epidemiology, and End Results database from January 2004 to December 2009. Significant variables were selected by use of the backward stepwise method. The nomogram was constructed with multivariable Cox regression. The model's performance was evaluated by concordance index and calibration curve. The model was validated via an independent cohort from the Jiangsu Cancer Hospital Lung Cancer Center.

RESULTS

A total of 1809 patients with stage IIIA-N2 NSCLC who underwent surgery were included in the training cohort. Age, sex, grade, histology, tumor size, visceral pleural invasion, positive lymph nodes, lymph nodes examined, and surgery type (lobectomy vs pneumonectomy) were identified as significant prognostic variables using backward stepwise method. A nomogram was developed from the training cohort and validated using an independent Chinese cohort. The concordance index of the model was 0.673 (95% confidence interval, 0.654-0.692) in training cohort and 0.664 in validation cohort (95% confidence interval, 0.614-0.714). The calibration plot showed optimal consistency between nomogram predicted survival and observed survival. Survival analyses demonstrated significant differences between different subgroups stratified by prognostic scores.

CONCLUSIONS

This nomogram provided the individual survival prediction for patients with stage IIIA-N2 NSCLC after surgery, which might benefit survival counseling for patients and clinicians, clinical trial design and follow-up, as well as postoperative strategy-making.