Prognostic factors and in particular which pattern of lymph node metastases better predict prognosis in NSCLC with N2 up-staging are not well investigated yet. We reviewed the data of 550 patients and pointed out the role of lymph node ratio and of adjuvant therapy to improve overall and cancer-specific survival in these patients. Background: Unexpected N2 involvement occurs in approximately 10% to 20% of patients with non-small-cell lung cancer (NSCLC) and patients' prognostic factors remain unclear. The aimof this studywas to evaluate prognostic factors in these patients. Methods: From January 2002 to December 2012, we retrospectively analyzed data of 550 patients with NSCLC with preoperative negative, but pathologic positive N2 involvement, who underwent anatomical lung resection and hilo-mediastinal lymphadenectomy, obtained from 6 institutions. An established prognostic factor panel and N2-type involvement were correlated to overall (OS), cancer-specific (CSS), and disease-free survival (DFS) using multivariate Cox Regressionmodel. The following lymph node patterns were analyzed: number of resected nodes (#RNs), metastatic nodes (#MNs), ratio between #MNs and #RNs (NR), N2 subgroups proposed for the eighth TNMedition, and lobe-specific versus nonspecificmetastasis. Results: Regarding our cohort, 419 patients were staged IIIA (T1-2N2), 131 IIIB (T3-4N2), 113 pT1, 306 pT2, 94 pT3, and 37 pT4; 5-year OS, DFS, and CSS were 34.1%, 20.1%, and 64.6%, respectively. Independent prognostic factor for OS, in the multivariable analysis, were as follows: NR <17% (P=.009), proposed N2 classification subgroups (P=.014), age<66 (P<.001), and pT (P=.005); forDFS: NR<17%(P=.003), adjuvant treatment (P=.026), and pT (P=.026); and for CSS: NR <17% (P=.008), grading (P=.001), and adjuvant treatment (P <.001). Conclusion: Our study confirms that adjuvant therapy is fundamental and NR, in patients with unexpected N2 involvement, has a strong prognostic factor. In particular, a NR cutoff value of 17% could predict OS, DFS, and CSS in patients with NSCLC. (C) 2020 Elsevier Inc. All rights reserved.

Mediastinal Up-Staging During Surgery in Non–Small-Cell Lung Cancer: Which Mediastinal Lymph Node Metastasis Patterns Better Predict The Outcome? A Multicenter Analysis

Felice Mucilli;
2020

Abstract

Prognostic factors and in particular which pattern of lymph node metastases better predict prognosis in NSCLC with N2 up-staging are not well investigated yet. We reviewed the data of 550 patients and pointed out the role of lymph node ratio and of adjuvant therapy to improve overall and cancer-specific survival in these patients. Background: Unexpected N2 involvement occurs in approximately 10% to 20% of patients with non-small-cell lung cancer (NSCLC) and patients' prognostic factors remain unclear. The aimof this studywas to evaluate prognostic factors in these patients. Methods: From January 2002 to December 2012, we retrospectively analyzed data of 550 patients with NSCLC with preoperative negative, but pathologic positive N2 involvement, who underwent anatomical lung resection and hilo-mediastinal lymphadenectomy, obtained from 6 institutions. An established prognostic factor panel and N2-type involvement were correlated to overall (OS), cancer-specific (CSS), and disease-free survival (DFS) using multivariate Cox Regressionmodel. The following lymph node patterns were analyzed: number of resected nodes (#RNs), metastatic nodes (#MNs), ratio between #MNs and #RNs (NR), N2 subgroups proposed for the eighth TNMedition, and lobe-specific versus nonspecificmetastasis. Results: Regarding our cohort, 419 patients were staged IIIA (T1-2N2), 131 IIIB (T3-4N2), 113 pT1, 306 pT2, 94 pT3, and 37 pT4; 5-year OS, DFS, and CSS were 34.1%, 20.1%, and 64.6%, respectively. Independent prognostic factor for OS, in the multivariable analysis, were as follows: NR <17% (P=.009), proposed N2 classification subgroups (P=.014), age<66 (P<.001), and pT (P=.005); forDFS: NR<17%(P=.003), adjuvant treatment (P=.026), and pT (P=.026); and for CSS: NR <17% (P=.008), grading (P=.001), and adjuvant treatment (P <.001). Conclusion: Our study confirms that adjuvant therapy is fundamental and NR, in patients with unexpected N2 involvement, has a strong prognostic factor. In particular, a NR cutoff value of 17% could predict OS, DFS, and CSS in patients with NSCLC. (C) 2020 Elsevier Inc. All rights reserved.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11564/721976
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