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Purpose <p>To elucidate the potential reasons for the favourable prognosis of positron emission tomography/computed tomography (PET/CT)-defined occult N2 metastasis and its survival effect in the context of the newly proposed ninth edition N descriptors.</p> Methods <p>A total of 3565 patients who underwent preoperative PET/CT and surgical resection for non-small cell lung cancer were retrospectively included. Survival analysis was conducted using the Kaplan–Meier method and Cox proportional hazards model.</p> Results <p>The incidence of single-station involvement was significantly higher (<i>p</i> &lt; .001) in occult N2 metastasis (117/191, 61.3%) compared to evident N2 metastasis (83/198, 41.9%). The survival rates of patients with occult N2a (single-station N2 involvement) and occult N2b (multiple-station N2 involvement) were comparable to those of patients with clinically evident N2a and N2b, respectively (adjusted <i>p</i> &gt;.20 for all). Conversely, single-station involvement was associated with a markedly superior prognosis than multiple-station involvement, whether for patients with occult N2 metastasis (5-year overall survival [OS]: 62.7% vs 50.1%, adjusted <i>p</i> = .04) or patients with clinically evident N2 metastasis (5-year OS: 50.3% vs 36.2%, adjusted <i>p</i> = .03). Cox regression analysis of the pathological N2 population further indicated that multiple-station involvement was a more robust prognostic factor than occult lymph node metastasis.</p> Conclusions <p>The favourable prognosis of PET/CT-defined occult N2 metastasis may be attributed to the discrepancy in prognosis and proportion between occult N2a and clinically evident N2b. This external validation provided substantial evidence supporting the reasonableness and robustness of the newly proposed ninth edition N descriptors.</p>

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Survival effect of PET/CT-defined occult lymph node metastasis in the newly proposed ninth edition N descriptors: a multicentre study

  • 期刊论文

  • 发表日期：

    2025年9月23日

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  • Xinchen Shen,
  • Tao Chen,
  • Juemin Yu,
  • Jialiang Wen,
  • Haoran Ji,
  • Zihan Guo,
  • Minglei Yang,
  • Bentong Yu,
  • Yongxiang Song,
  • Yangchun Chen,
  • Long Zhao,
  • Likun Hou,
  • Longbing Ren,
  • Deping Zhao,
  • Yunlang She,
  • Chang Chen,
  • Dong Xie,
  • Jiajun Deng

摘要

Purpose

To elucidate the potential reasons for the favourable prognosis of positron emission tomography/computed tomography (PET/CT)-defined occult N2 metastasis and its survival effect in the context of the newly proposed ninth edition N descriptors.

Methods

A total of 3565 patients who underwent preoperative PET/CT and surgical resection for non-small cell lung cancer were retrospectively included. Survival analysis was conducted using the Kaplan–Meier method and Cox proportional hazards model.

Results

The incidence of single-station involvement was significantly higher (p < .001) in occult N2 metastasis (117/191, 61.3%) compared to evident N2 metastasis (83/198, 41.9%). The survival rates of patients with occult N2a (single-station N2 involvement) and occult N2b (multiple-station N2 involvement) were comparable to those of patients with clinically evident N2a and N2b, respectively (adjusted p >.20 for all). Conversely, single-station involvement was associated with a markedly superior prognosis than multiple-station involvement, whether for patients with occult N2 metastasis (5-year overall survival [OS]: 62.7% vs 50.1%, adjusted p = .04) or patients with clinically evident N2 metastasis (5-year OS: 50.3% vs 36.2%, adjusted p = .03). Cox regression analysis of the pathological N2 population further indicated that multiple-station involvement was a more robust prognostic factor than occult lymph node metastasis.

Conclusions

The favourable prognosis of PET/CT-defined occult N2 metastasis may be attributed to the discrepancy in prognosis and proportion between occult N2a and clinically evident N2b. This external validation provided substantial evidence supporting the reasonableness and robustness of the newly proposed ninth edition N descriptors.