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

Giovanni Leuzzi, Filippo Lococo, Gabriele Alessandrini, Isabella Sperduti, Lorenzo Spaggiari, Federico Venuta, Erino A. Rendina, Pierluigi M. Granone, Cristian Rapicetta, Piero Zannini, Gaetano Di Rienzo, Maurizio Nicolosi, Francesco Facciolo

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Abstract

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.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalLung
DOIs
Publication statusAccepted/In press - Oct 13 2016

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Small Cell Lung Carcinoma
Survival
Recurrence
Lymph Node Excision
Proportional Hazards Models
Neoplasms
Multivariate Analysis
Lymph Nodes

Keywords

  • Lymphadenectomy
  • Multimodality therapy
  • Node-spreading pattern
  • Ratio
  • Small-cell lung cancer
  • Surgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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

In: Lung, 13.10.2016, p. 1-8.

Research output: Contribution to journalArticle

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. / Prognostic Impact of Node-Spreading Pattern in Surgically Treated Small-Cell Lung Cancer : A Multicentric Analysis. In: Lung. 2016 ; pp. 1-8.
@article{1886b268afb5485081423ee83d294712,
title = "Prognostic Impact of Node-Spreading Pattern in Surgically Treated Small-Cell Lung Cancer: A Multicentric Analysis",
abstract = "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.",
keywords = "Lymphadenectomy, Multimodality therapy, Node-spreading pattern, Ratio, Small-cell lung cancer, Surgery",
author = "Giovanni Leuzzi and Filippo Lococo and Gabriele Alessandrini and Isabella Sperduti and Lorenzo Spaggiari and Federico Venuta and Rendina, {Erino A.} and Granone, {Pierluigi M.} and Cristian Rapicetta and Piero Zannini and {Di Rienzo}, Gaetano and Maurizio Nicolosi and Francesco Facciolo",
year = "2016",
month = "10",
day = "13",
doi = "10.1007/s00408-016-9954-4",
language = "English",
pages = "1--8",
journal = "Lung",
issn = "0341-2040",
publisher = "Springer New York",

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TY - JOUR

T1 - Prognostic Impact of Node-Spreading Pattern in Surgically Treated Small-Cell Lung Cancer

T2 - A Multicentric Analysis

AU - Leuzzi, Giovanni

AU - Lococo, Filippo

AU - Alessandrini, Gabriele

AU - Sperduti, Isabella

AU - Spaggiari, Lorenzo

AU - Venuta, Federico

AU - Rendina, Erino A.

AU - Granone, Pierluigi M.

AU - Rapicetta, Cristian

AU - Zannini, Piero

AU - Di Rienzo, Gaetano

AU - Nicolosi, Maurizio

AU - Facciolo, Francesco

PY - 2016/10/13

Y1 - 2016/10/13

N2 - 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.

AB - 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.

KW - Lymphadenectomy

KW - Multimodality therapy

KW - Node-spreading pattern

KW - Ratio

KW - Small-cell lung cancer

KW - Surgery

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