@article{JTD125594,
author = {Huanrong Zhang and Rong Wang and Haihui Zhong and Peigui Gu},
title = {Examined lymph node count and survival in resected non-small cell lung cancer: attenuation of benefit beyond 16 nodes is confined to node-negative disease},
journal = {Journal of Thoracic Disease},
volume = {0},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Adequate lymph node (LN) examination during resection of non-small cell lung cancer (NSCLC) underpins accurate staging, but the number of examined lymph nodes (ELNs) beyond which additional retrieval confers no further benefit remains uncertain, and it is not known whether any single threshold applies across nodal stages.Methods: We analysed 61,994 patients undergoing resection for NSCLC in the program (SEER) 17 registry (2010–2019). The detection of nodal metastasis was assessed as the proportion of node-positive cases and the mean number of positive nodes across ELN categories. Non-linearity was examined with restricted cubic splines. A threshold of 16 nodes, proposed in earlier work, was pre-specified and tested using a two-piecewise Cox model rather than derived from these data; the analysis was repeated across candidate breakpoints from 10 to 30 and separately by pathological N stage and extent of resection. Internal validation used split-sample and bootstrap resampling.Results: The median ELN count was 9 (interquartile range, 5–15). Regression analyses included the 59,961 patients with 1 to 30 nodes examined, among whom 18,849 deaths occurred. After full adjustment, each increment of 5 ELNs was associated with higher odds of node-positive disease [odds ratio (OR) 1.19; 95% confidence interval (CI): 1.17–1.22] and lower mortality [hazard ratio (HR) 0.94; 95% CI: 0.92–0.95]. Below 16 nodes, each additional node was associated with a 2.1% reduction in the hazard of death (HR 0.979; 95% CI: 0.976–0.983; P},
issn = {2077-6624}, url = {https://jtd.amegroups.org/article/view/125594}
}