The value of the logarithmic ratio of positive lymph nodes in predicting the prognosis of patients with locally advanced non-small cell lung cancer

LV Quanxi; LV Zhihao; WU Tiecheng; LU Yongchang; GUO Lili

doi:10.3969/j.issn.1009-0460.2025.06.002

Abstract：Objective To explore the value of positive lymph node logarithmic ratio(LN-LOR)in predicting the prognosis of patients with locally advanced non-small cell lung cancer(NSCLC)who receive neoadjuvant chemoradiotherapy and surgery.Methods The clinical medical records of 185 patients with locally advanced NSCLC who received neoadjuvant chemoradiotherapy and surgical treatment at Handan First Hospital from March 2020 to December 2021 were retrospectively collected.Ln-lor is defined as the logarithm of the ratio of positive lymph nodes to negative lymph nodes during lymph node dissection,and the calculation formula is log[(positive LN+0.5)/(dissected LN-positive LN+0.5)].The overall survival(OS),disease-free survival(DFS)and local regional recurrence(LRR)of the patients were followed up.Results The median value of LN-LOR was-0.20(-1.41 to 1.67).According to the median value,they were divided into the low-risk LN-LOR group and the high-risk LN-LOR group.The pN stage,the number of involved lymph node stations and the lymph node ratio were higher in the high-risk LN-LOR group.Moreover,patients with positive LN at the 7th station tended to occur more frequently in the high-risk LN-LOR group(P<0.05).The median follow-up time of the patients was 36(9.93-36)months.There were 85 deaths,99 cases of progression,and 52 cases of local recurrence.Before treatment,LN-LOR in deceased patients was significantly higher than that in surviving patients[-0.10(-0.36,0.21)vs.-0.35(-0.50,-0.16),Z=-2.904,P=0.004];The LN-LOR in patients with progression and local recurrence was also significantly higher than that in patients without progression[-0.10(-0.35,0.21)vs.-0.28(-0.49,-0.13),Z=-3.126,P=0.002]and those without local recurrence[-0.11(-0.35,0.30)vs.-0.29(-0.52,-0.11),Z=-2.597,P=0.009].Analysis by the Cox proportional hazards regression model showed that LN-LOR≥-0.20 was an independent risk factor affecting OS,DFS and LRR in patients with locally advanced NSCLC(P<0.05).Compared with the low-risk LN-LOR group,the median OS of patients in the high-risk LN-LOR group was shorter(36 months vs.31 months,Log rank χ2=10.519,P=0.001);The median DFS(31 months vs.14.29 months,Log rank χ2=14.473,P<0.001)and the median no-LRR(32 months vs.18.66 months,Log rank χ2=13.440,P<0.001)were also significantly shortened.In the high-risk group of LN-LOR,the median OS,DFS and non-LRR of patients in ypN1-2 stage were also significantly shorter than those of patients in ypN0/X stage(P<0.05).Conclusion LN-LOR is significantly correlated with the prognosis of patients with locally advanced NSCLC and can better reflect the burden of LN and the biological behavior of the disease.