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Peer-reviewedCC BY-NC-NDBMC cancer

Examined lymph node count as an independent predictive biomarker for adjuvant systemic therapy efficacy in stage IB lung adenocarcinoma.

  • Ruifeng Xu1
  • Zhiwen Luo2
  • Hai Chen3
  • Na Ren1
  • Hongrui Wang1
  • Zeyuan Zhao1
  • Chao Zhang4
  • Dongliang Yang3
  • Hongsheng Xue5
  • Liang Zhao6
  • Yun Che7
7 affiliations
  1. 1Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
  2. 2Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
  3. 3The Second Department of Thoracic Surgery, Anhui Chest Hospital, Anhui, 230022, China.
  4. 4Department of Thoracic Surgery, the Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China.
  5. 5Department of Thoracic Surgery, the Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, China. [email protected].
  6. 6Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. [email protected].
  7. 7Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. [email protected].
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Abstract

Background

Adjuvant systemic therapy (AST) utility for stage IB lung adenocarcinoma (LUAD) remains controversial due to the lack of objective metrics for staging adequacy. We aimed to establish an evidence-based threshold for "unknown nodal status" (Nx) and evaluate examined lymph node (ELN) count as a predictive biomarker for AST benefit.Methods

Data from a multicenter cohort (N = 443) and SEER database (N = 4,636) were analyzed. Adjuvant systemic therapy (AST) in this study specifically referred to traditional platinum-based doublet chemotherapy. LOWESS regression identified mortality risk inflection points. Propensity score matching (PSM, SMD ≤ 0.12) evaluated AST efficacy across ELN strata.Results

LOWESS modeling identified 11 ELNs as the optimal staging threshold. In the local cohort, patients with < 11 ELNs without AST had significantly worse survival ( P < 0.0001); however, AST was associated with significantly improved survival in this subgroup(Adjusted HR 0.24, 95% CI 0.07-0.89, P = 0.033). This compensatory trend was corroborated by SEER (P = 0.0033). Conversely, for thoroughly evaluated "true N0" patients (≥ 11 ELNs), AST provided no survival improvement (Adjusted HR 0.94, 95% CI 0.27-3.19, P = 0.916).Conclusions

ELN count is a robust gatekeeper for AST efficacy. An ELN < 11 could help clarify Nx status and serve as a strong clinical indicator suggesting potential benefit from AST in stage IB LUAD.Trial registration

The study was approved by the Ethics Committee of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (IRB -24/660-4940). All participants provided written informed consent.

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Cite

BibTeXRIS
BibTeX
@article{xu2026examined,
  title = {{Examined lymph node count as an independent predictive biomarker for adjuvant systemic therapy efficacy in stage IB lung adenocarcinoma.}},
  author = {Ruifeng Xu and Zhiwen Luo and Hai Chen and Na Ren and Hongrui Wang and Zeyuan Zhao and Chao Zhang and Dongliang Yang and Hongsheng Xue and Liang Zhao and Yun Che},
  journal = {BMC cancer},
  year = {2026},
  month = jul,
  doi = {10.1186/s12885-026-16593-z},
  url = {https://europepmc.org/article/MED/42958123},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Examined lymph node count as an independent predictive biomarker for adjuvant systemic therapy efficacy in stage IB lung adenocarcinoma.
AU  - Ruifeng Xu
AU  - Zhiwen Luo
AU  - Hai Chen
AU  - Na Ren
AU  - Hongrui Wang
AU  - Zeyuan Zhao
AU  - Chao Zhang
AU  - Dongliang Yang
AU  - Hongsheng Xue
AU  - Liang Zhao
AU  - Yun Che
PY  - 2026
DA  - 2026/07/31
JO  - BMC cancer
DO  - 10.1186/s12885-026-16593-z
UR  - https://europepmc.org/article/MED/42958123
AB  - Background  Adjuvant systemic therapy (AST) utility for stage IB lung adenocarcinoma (LUAD) remains controversial due to the lack of objective metrics for staging adequacy. We aimed to establish an evidence-based threshold for "unknown nodal status" (Nx) and evaluate examined lymph node (ELN) count as a predictive biomarker for AST benefit.Methods  Data from a multicenter cohort (N = 443) and SEER database (N = 4,636) were analyzed. Adjuvant systemic therapy (AST) in this study specifically referred to traditional platinum-based doublet chemotherapy. LOWESS regression identified mortality risk inflection points. Propensity score matching (PSM, SMD ≤ 0.12) evaluated AST efficacy across ELN strata.Results  LOWESS modeling identified 11 ELNs as the optimal staging threshold. In the local cohort, patients with < 11 ELNs without AST had significantly worse survival ( P < 0.0001); however, AST was associated with significantly improved survival in this subgroup(Adjusted HR 0.24, 95% CI 0.07-0.89, P = 0.033). This compensatory trend was corroborated by SEER (P = 0.0033). Conversely, for thoroughly evaluated "true N0" patients (≥ 11 ELNs), AST provided no survival improvement (Adjusted HR 0.94, 95% CI 0.27-3.19, P = 0.916).Conclusions  ELN count is a robust gatekeeper for AST efficacy. An ELN < 11 could help clarify Nx status and serve as a strong clinical indicator suggesting potential benefit from AST in stage IB LUAD.Trial registration  The study was approved by the Ethics Committee of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (IRB -24/660-4940). All participants provided written informed consent.
SN  - 1471-2407
ER  -