Prognostic Impact of Node-Spreading Pattern in Surgically Treated Small-Cell Lung Cancer: A Multicentric Analysis

• Published in: Lung Vol. 195; no. 1; pp. 107 - 114
• Main Authors: Leuzzi, Giovanni, Lococo, Filippo, Alessandrini, Gabriele, Sperduti, Isabella, Spaggiari, Lorenzo, Venuta, Federico, Rendina, Erino A., Granone, Pierluigi M., Rapicetta, Cristian, Zannini, Piero, Di Rienzo, Gaetano, Nicolosi, Maurizio, Facciolo, Francesco
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2017; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - therapy; Chemotherapy, Adjuvant; Disease-Free Survival; Female; Humans; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Lymph Node Excision; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Pneumology/Respiratory System; Pneumonectomy; Radiotherapy, Adjuvant; Retrospective Studies; Surgery; Survival Rate; Tumor Burden; Multimodality therapy; Lymphadenectomy; Ratio; Small-cell lung cancer; Node-spreading pattern; Surgery
• ISSN: 0341-2040; 1432-1750
• DOI: 10.1007/s00408-016-9954-4

Objective Although surgery in selected small-cell lung cancer (SCLC) patients has been proposed as a part of multimodality therapy, so far, the prognostic impact of node-spreading pattern has not been fully elucidated. To investigate this issue, a retrospective analysis was performed. Methods From 01/1996 to 12/2012, clinico-pathological, surgical, and oncological features were retrospectively reviewed in a multicentric cohort of 154 surgically treated SCLC patients. A multivariate Cox proportional hazard model was developed using stepwise regression, in order to identify independent outcome predictors. Overall (OS), cancer-specific (CSS), and Relapse-free survival (RFS) were calculated by Kaplan-Meier method. Results Overall, median OS, CSS, and RFS were 29 (95 % CI 18–39), 48 (95 % CI 19–78), and 22 (95 % CI 17–27) months, respectively. Lymphadenectomy was performed in 140 (90.9 %) patients (median number of harvested nodes: 11.5). Sixty-seven (47.9 %) pN0-cases experienced the best long-term survival (CSS: 71, RFS: 62 months; p  < 0.0001). Among node-positive patients, no prognostic differences were found between pN1 and pN2 involvement (CSS: 22 vs. 15, and RFS: 14 vs. 10 months, respectively; p  = 0.99). By splitting node-positive SCLC according to concurrent N1-invasion, N0N2-patients showed a worse CSS compared to those cases with combined N1N2-involvement (N0N2: 8 months vs. N1N2: 22 months; p  = 0.04). On the other hand, the number of metastatic stations ( p  = 0.80) and the specific node-level ( p  = 0.85) did not affect CSS. At multivariate analysis, pN+ (HR: 3.05, 95 % CI 1.21–7.67, p  = 0.02) and ratio between metastatic and resected lymph-nodes (RL, HR: 1.02, 95 % CI 1.00–1.04, p  = 0.03) were independent predictors of CSS. Moreover, node-positive patients (HR: 3.60, 95 % CI 1.95–6.63, p  < 0.0001) with tumor size ≥5 cm (HR: 1.85, 95 % CI 0.88–3.88, p  = 0.10) experienced a worse RFS. Conclusions In selected surgically treated SCLC, the long-term survival may be stratified according to the node-spreading pattern.