Marco Chiappetta1,2, Filippo Lococo1,2, Giovanni Leuzzi3, Isabella Sperduti4, Emilio Bria1,5, Leonardo Petracca Ciavarella1,2, Felice Mucilli6, Pier Luigi Filosso7, Giovannibattista Ratto8, Lorenzo Spaggiari9, Francesco Facciolo10, Stefano Margaritora1,2. 1. Università Cattolica del Sacro Cuore, 00168 Rome, Italy. 2. Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy. 3. Thoracic Surgery, Unit Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy. 4. Biostatistics, Regina Elena National Cancer Institute-IRCCS, 00100 Rome, Italy. 5. Medical Oncology, IRCCS Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy. 6. Department of General and Thoracic Surgery, University Hospital "SS. Annunziata", 66100 Chieti, Italy. 7. Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, 10126 Turin, Italy. 8. Division of Thoracic Surgery, IRCCS AOU "San Martino" IST, 16132 Genoa, Italy. 9. Thoracic Surgery Division, European Institute of Oncology, University of Milan, 20141 Milan, Italy. 10. Thoracic Surgery, Regina Elena National Cancer Institute, 00100 Rome, Italy.
Abstract
BACKGROUND: Prognostic factors in patients with single mediastinal station (sN2) involvement continues to be a debated issue. METHODS: Data on 213 adenocarcinoma patients with sN2 involvement and who had undergone complete anatomical lung resection and lymphadenectomy, were retrospectively reviewed. Clinical and pathological characteristics together with adjuvant therapy (AD) and node (N) status classifications (number of resected nodes (#RN), number of metastatic nodes (#MN), and node ratio (#MN/#RN = NR) were analyzed. RESULTS: Univariable analysis confirmed that age (0.009), #MN (0.009), NR (0.003), #N1 involved stations (p = 0.003), and skip metastases (p = 0.005) were related to overall survival (OS). Multivariable analysis confirmed, as independent prognostic factors, age <66 years and NR with a three-year OS (3YOS) of 78.7% in NR < 10% vs. 46.6% in NR > 10%. In skip metastases, NR (HR 2.734, 95% CI 1.417-5.277, p = 0.003) and pT stage (HR2.136, 95% CI 1.001-4.557, p = 0.050) were confirmed as independent prognostic factors. AD did not influence the OS of patients with singular positive lymph nodes (p = 0.41), while in patients with multiple lymph nodes and AD, a significantly better 3YOS was demonstrated, i.e., 49.1% vs. 30% (p = 0.004). In patients with N2 + N1 involvement, age (p = 0.002) and AD (p = 0.022) were favorable prognostic factors. CONCLUSIONS: Adenocarcinoma patients with single N2 station involvement had a favorable outcome in the case of skip metastases and low NR. Adjuvant therapy improves survival with multiple nodal involvement, while its role in single node involvement should be clarified.
BACKGROUND: Prognostic factors in patients with single mediastinal station (sN2) involvement continues to be a debated issue. METHODS: Data on 213 adenocarcinomapatients with sN2 involvement and who had undergone complete anatomical lung resection and lymphadenectomy, were retrospectively reviewed. Clinical and pathological characteristics together with adjuvant therapy (AD) and node (N) status classifications (number of resected nodes (#RN), number of metastatic nodes (#MN), and node ratio (#MN/#RN = NR) were analyzed. RESULTS: Univariable analysis confirmed that age (0.009), #MN (0.009), NR (0.003), #N1 involved stations (p = 0.003), and skip metastases (p = 0.005) were related to overall survival (OS). Multivariable analysis confirmed, as independent prognostic factors, age <66 years and NR with a three-year OS (3YOS) of 78.7% in NR < 10% vs. 46.6% in NR > 10%. In skip metastases, NR (HR 2.734, 95% CI 1.417-5.277, p = 0.003) and pT stage (HR2.136, 95% CI 1.001-4.557, p = 0.050) were confirmed as independent prognostic factors. AD did not influence the OS of patients with singular positive lymph nodes (p = 0.41), while in patients with multiple lymph nodes and AD, a significantly better 3YOS was demonstrated, i.e., 49.1% vs. 30% (p = 0.004). In patients with N2 + N1 involvement, age (p = 0.002) and AD (p = 0.022) were favorable prognostic factors. CONCLUSIONS:Adenocarcinomapatients with single N2 station involvement had a favorable outcome in the case of skip metastases and low NR. Adjuvant therapy improves survival with multiple nodal involvement, while its role in single node involvement should be clarified.
Entities:
Keywords:
NSCLC; adenocarcinoma; adjuvant therapy; lymph node; surgery
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