title: Does Lymph Node Metastasis Have a Negative Prognostic Impact in Patients with NSCLC and M1a Disease?
abstract: Patients with NSCLC with M1a disease regardless of lymph node status were categorized as stage IV. This study aims to investigate whether the N descriptors in M1a patients could provide clinical information.
  
  
  
  Overall, 39,731 patients with NSCLC with M1a disease were identified from the Surveillance, Epidemiology, and End Results database during 2005-2012. Lung cancer-specific survival (LCSS) was compared among M1a patients stratified by N stage. A Cox proportional hazards regression model was applied to evaluate the prognostic factors. Statistical analyses were performed in all subgroups.
  
  
  
  M1a patients without lymph node involvement had the best LCSS, followed by patients with N1 disease; no difference in LCSS was observed between N2 and N3 disease (N0 versus N1, p < 0.001; N1 versus N2, p < 0.001; and N2 versus N3, p = 0.478). Similarly, this trend was observed when patients were subdivided into two temporal cohorts (2005-2008 and 2009-2012) and also when M1a disease was subdivided into contralateral pulmonary nodules and pleural dissemination (malignant pleural effusion [or pericardial effusion] and pleural nodules). In addition, a difference in LCSS between N2 and N3 disease was observed in patients with malignant pleural nodules (p = 0.003). Multivariate analysis showed that lymph node involvement was an independent prognostic factor for M1a patients, and this result was also noticed in all subgroups.
  
  
  
  These results provide preliminary evidence that lymph node stage may have clinical significance among patients with NSCLC with M1a disease, adding prognostic information.
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors: Chenyang
authors: C
authors: Dai
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors: Yijiu
authors: Y
authors: Ren
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors: Dong
authors: D
authors: Xie
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors: Hui
authors: H
authors: Zheng
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors: Yunlang
authors: Y
authors: She
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors: Ke
authors: K
authors: Fei
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
authors: Gening
authors: G
authors: Jiang
authors: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China. Electronic address: chenthoracic@163.com.
authors: Chang
authors: C
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
keywords: M1a disease; NSCLC; SEER; Staging