Lymph-node ratio predicts survival among the different stages of non-small-cell lung cancer: A multicentre analysis

Marco Chiappetta, Giovanni Leuzzi, Isabella Sperduti, Emilio Bria, Felice Mucilli, Filippo Lococo, Lorenzo Spaggiari, Giovanni Battista Ratto, Pier Luigi Filosso, Francesco Facciolo

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The prognostic role of the number of resected and metastatic lymph nodes in non-small-cell lung cancer (NSCLC) is still being debated. The aim of this study was to evaluate the impact of lymphadenectomy in addition to the already validated variables in NSCLC survival. METHODS: From January 2002 to December 2012, data on 4858 patients with NSCLC undergoing anatomical lung resection and hilomediastinal lymphadenectomy in 6 institutions were analysed retrospectively. Established prognostic factors in addition to the number of resected lymph nodes and the ratio between the number of metastatic lymph nodes and the number of resected lymph nodes (NR) were correlated to overall survival (OS) and disease-free survival (DFS) using the multivariable Cox regression model. Harrell's C-statistic with the 95% confidence interval (CI) was determined. Analysis by means of maximally selected log-rank statistics was performed to find optimal cut-off points in order to split patients into groups with different outcome probabilities. RESULTS: The median numbers of resected lymph nodes and of metastatic lymph nodes were 17 (range 6-85) and 2 (1-36), respectively. Hilar (N1) and mediastinal (N2) metastases were identified in 21.3% and 20.0% of cases, respectively. Overall, the 5-year OS and DFS rates were 54.6% and 44.8%, respectively. At multivariable analysis, age, gender, pathological stage, R0 resection, type of surgery and NR correlated with longer OS rates; the same variables plus tumour grading were further related to DFS. C-statistics were 66.0 (95% CI 62.7-69.4) for DFS and 60.5 (95% CI 58.3-62.6) for OS. An NR <40% significantly correlated with a higher 5-year survival rate in the total sample (OS 57.6% vs 23.8%, P < 0.001; DFS 48.2% vs 11.4, P < 0.001) and in patients with N1 (OS 47.9% vs 36.1%, P = 0.03; DFS 39% vs 24.2%, P = 0.02) and N2 (OS 36.9% vs 21.8%, P < 0.001 DFS 23.9% vs 9.1%, P < 0.001). Our study confirms that the number of resected lymph nodes is a strong prognostic indicator in NSCLC. In particular, an NR cut-off value of 40% may predict both OS and DFS.

Original languageEnglish
Pages (from-to)405-412
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume55
Issue number3
DOIs
Publication statusPublished - Mar 1 2019

Fingerprint

Non-Small Cell Lung Carcinoma
Disease-Free Survival
Lymph Nodes
Survival
Survival Rate
Confidence Intervals
Lymph Node Excision
Neoplasm Grading
Proportional Hazards Models
Neoplasm Metastasis
Lung

Keywords

  • Lung surgery
  • Lymph nodes metastasis
  • Lymph-node ratio
  • Non-small-cell lung cancer

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Lymph-node ratio predicts survival among the different stages of non-small-cell lung cancer : A multicentre analysis. / Chiappetta, Marco; Leuzzi, Giovanni; Sperduti, Isabella; Bria, Emilio; Mucilli, Felice; Lococo, Filippo; Spaggiari, Lorenzo; Ratto, Giovanni Battista; Filosso, Pier Luigi; Facciolo, Francesco.

In: European Journal of Cardio-thoracic Surgery, Vol. 55, No. 3, 01.03.2019, p. 405-412.

Research output: Contribution to journalArticle

@article{333e8b32469b4927924864005ae00994,
title = "Lymph-node ratio predicts survival among the different stages of non-small-cell lung cancer: A multicentre analysis",
abstract = "The prognostic role of the number of resected and metastatic lymph nodes in non-small-cell lung cancer (NSCLC) is still being debated. The aim of this study was to evaluate the impact of lymphadenectomy in addition to the already validated variables in NSCLC survival. METHODS: From January 2002 to December 2012, data on 4858 patients with NSCLC undergoing anatomical lung resection and hilomediastinal lymphadenectomy in 6 institutions were analysed retrospectively. Established prognostic factors in addition to the number of resected lymph nodes and the ratio between the number of metastatic lymph nodes and the number of resected lymph nodes (NR) were correlated to overall survival (OS) and disease-free survival (DFS) using the multivariable Cox regression model. Harrell's C-statistic with the 95{\%} confidence interval (CI) was determined. Analysis by means of maximally selected log-rank statistics was performed to find optimal cut-off points in order to split patients into groups with different outcome probabilities. RESULTS: The median numbers of resected lymph nodes and of metastatic lymph nodes were 17 (range 6-85) and 2 (1-36), respectively. Hilar (N1) and mediastinal (N2) metastases were identified in 21.3{\%} and 20.0{\%} of cases, respectively. Overall, the 5-year OS and DFS rates were 54.6{\%} and 44.8{\%}, respectively. At multivariable analysis, age, gender, pathological stage, R0 resection, type of surgery and NR correlated with longer OS rates; the same variables plus tumour grading were further related to DFS. C-statistics were 66.0 (95{\%} CI 62.7-69.4) for DFS and 60.5 (95{\%} CI 58.3-62.6) for OS. An NR <40{\%} significantly correlated with a higher 5-year survival rate in the total sample (OS 57.6{\%} vs 23.8{\%}, P < 0.001; DFS 48.2{\%} vs 11.4, P < 0.001) and in patients with N1 (OS 47.9{\%} vs 36.1{\%}, P = 0.03; DFS 39{\%} vs 24.2{\%}, P = 0.02) and N2 (OS 36.9{\%} vs 21.8{\%}, P < 0.001 DFS 23.9{\%} vs 9.1{\%}, P < 0.001). Our study confirms that the number of resected lymph nodes is a strong prognostic indicator in NSCLC. In particular, an NR cut-off value of 40{\%} may predict both OS and DFS.",
keywords = "Lung surgery, Lymph nodes metastasis, Lymph-node ratio, Non-small-cell lung cancer",
author = "Marco Chiappetta and Giovanni Leuzzi and Isabella Sperduti and Emilio Bria and Felice Mucilli and Filippo Lococo and Lorenzo Spaggiari and Ratto, {Giovanni Battista} and Filosso, {Pier Luigi} and Francesco Facciolo",
year = "2019",
month = "3",
day = "1",
doi = "10.1093/ejcts/ezy311",
language = "English",
volume = "55",
pages = "405--412",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "3",

}

TY - JOUR

T1 - Lymph-node ratio predicts survival among the different stages of non-small-cell lung cancer

T2 - A multicentre analysis

AU - Chiappetta, Marco

AU - Leuzzi, Giovanni

AU - Sperduti, Isabella

AU - Bria, Emilio

AU - Mucilli, Felice

AU - Lococo, Filippo

AU - Spaggiari, Lorenzo

AU - Ratto, Giovanni Battista

AU - Filosso, Pier Luigi

AU - Facciolo, Francesco

PY - 2019/3/1

Y1 - 2019/3/1

N2 - The prognostic role of the number of resected and metastatic lymph nodes in non-small-cell lung cancer (NSCLC) is still being debated. The aim of this study was to evaluate the impact of lymphadenectomy in addition to the already validated variables in NSCLC survival. METHODS: From January 2002 to December 2012, data on 4858 patients with NSCLC undergoing anatomical lung resection and hilomediastinal lymphadenectomy in 6 institutions were analysed retrospectively. Established prognostic factors in addition to the number of resected lymph nodes and the ratio between the number of metastatic lymph nodes and the number of resected lymph nodes (NR) were correlated to overall survival (OS) and disease-free survival (DFS) using the multivariable Cox regression model. Harrell's C-statistic with the 95% confidence interval (CI) was determined. Analysis by means of maximally selected log-rank statistics was performed to find optimal cut-off points in order to split patients into groups with different outcome probabilities. RESULTS: The median numbers of resected lymph nodes and of metastatic lymph nodes were 17 (range 6-85) and 2 (1-36), respectively. Hilar (N1) and mediastinal (N2) metastases were identified in 21.3% and 20.0% of cases, respectively. Overall, the 5-year OS and DFS rates were 54.6% and 44.8%, respectively. At multivariable analysis, age, gender, pathological stage, R0 resection, type of surgery and NR correlated with longer OS rates; the same variables plus tumour grading were further related to DFS. C-statistics were 66.0 (95% CI 62.7-69.4) for DFS and 60.5 (95% CI 58.3-62.6) for OS. An NR <40% significantly correlated with a higher 5-year survival rate in the total sample (OS 57.6% vs 23.8%, P < 0.001; DFS 48.2% vs 11.4, P < 0.001) and in patients with N1 (OS 47.9% vs 36.1%, P = 0.03; DFS 39% vs 24.2%, P = 0.02) and N2 (OS 36.9% vs 21.8%, P < 0.001 DFS 23.9% vs 9.1%, P < 0.001). Our study confirms that the number of resected lymph nodes is a strong prognostic indicator in NSCLC. In particular, an NR cut-off value of 40% may predict both OS and DFS.

AB - The prognostic role of the number of resected and metastatic lymph nodes in non-small-cell lung cancer (NSCLC) is still being debated. The aim of this study was to evaluate the impact of lymphadenectomy in addition to the already validated variables in NSCLC survival. METHODS: From January 2002 to December 2012, data on 4858 patients with NSCLC undergoing anatomical lung resection and hilomediastinal lymphadenectomy in 6 institutions were analysed retrospectively. Established prognostic factors in addition to the number of resected lymph nodes and the ratio between the number of metastatic lymph nodes and the number of resected lymph nodes (NR) were correlated to overall survival (OS) and disease-free survival (DFS) using the multivariable Cox regression model. Harrell's C-statistic with the 95% confidence interval (CI) was determined. Analysis by means of maximally selected log-rank statistics was performed to find optimal cut-off points in order to split patients into groups with different outcome probabilities. RESULTS: The median numbers of resected lymph nodes and of metastatic lymph nodes were 17 (range 6-85) and 2 (1-36), respectively. Hilar (N1) and mediastinal (N2) metastases were identified in 21.3% and 20.0% of cases, respectively. Overall, the 5-year OS and DFS rates were 54.6% and 44.8%, respectively. At multivariable analysis, age, gender, pathological stage, R0 resection, type of surgery and NR correlated with longer OS rates; the same variables plus tumour grading were further related to DFS. C-statistics were 66.0 (95% CI 62.7-69.4) for DFS and 60.5 (95% CI 58.3-62.6) for OS. An NR <40% significantly correlated with a higher 5-year survival rate in the total sample (OS 57.6% vs 23.8%, P < 0.001; DFS 48.2% vs 11.4, P < 0.001) and in patients with N1 (OS 47.9% vs 36.1%, P = 0.03; DFS 39% vs 24.2%, P = 0.02) and N2 (OS 36.9% vs 21.8%, P < 0.001 DFS 23.9% vs 9.1%, P < 0.001). Our study confirms that the number of resected lymph nodes is a strong prognostic indicator in NSCLC. In particular, an NR cut-off value of 40% may predict both OS and DFS.

KW - Lung surgery

KW - Lymph nodes metastasis

KW - Lymph-node ratio

KW - Non-small-cell lung cancer

UR - http://www.scopus.com/inward/record.url?scp=85057819764&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057819764&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezy311

DO - 10.1093/ejcts/ezy311

M3 - Article

AN - SCOPUS:85057819764

VL - 55

SP - 405

EP - 412

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 3

ER -