Abstract
BACKGROUND: Surgery with systematic lymph node (LN) dissection remains the primary treatment for early-stage and locally advanced operable non-small-cell lung cancer (NSCLC). However, the effect of the log odds of negative lymph nodes/T stage (LONT) in NSCLC remains unclear. This study aims to evaluate the correlation between LONT and prognosis of stage I-III NSCLC patients who underwent resection. METHODS: Clinical data from patients who underwent NSCLC resection were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The log odds of negative LONT, defined as log(NLNs + 1)/T stage, was calculated for each patient. The nonlinear relationship between LONT and overall survival (OS) and lung cancer-specific survival (LCSS) was evaluated using the cubic spline smoothing technique and Cox regression. The optimal LONT cut-off point was determined using X-tile plots, and propensity score matching (PSM) was performed to minimize inter-group differences. RESULTS: LONT demonstrated a nonlinear positive relationship with both OS and LCSS. Based on X-tile plot-determined cut-off point of 0.60, participants were categorized into low (< 0.60) and high (≥ 0.60) LONT subgroups. Both before and after PSM, the high LONT group exhibited significantly better OS and LCSS compared to the low LONT group (both P < 0.001). Similar survival differences were observed in subgroup analyses based on lymph node status and TNM stage. LONT was an independent predictor of OS (HR: 0.78, 95% CI: 0.74-0.81, P < 0.001) and LCSS (HR: 0.75, 95% CI: 0.71-0.78, P < 0.001). CONCLUSIONS: LONT is a novel robust prognostic factor that could complement TNM staging system. A higher LONT is associated with better survival in stage I-III NSCLC patients who received resection.