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

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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.

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Acknowledgments

We would like to thank Ms. Tania Merlino for her assistance in revising the manuscript.

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Authors and Affiliations

  1. Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Giovanni Leuzzi

  2. Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy

    Filippo Lococo & Cristian Rapicetta

  3. Thoracic Surgery Unit, Regina Elena National Cancer Institute – IFO, Rome, Italy

    Gabriele Alessandrini & Francesco Facciolo

  4. Scientific Direction, Regina Elena National Cancer Institute – IFO, Rome, Italy

    Isabella Sperduti

  5. Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy

    Lorenzo Spaggiari

  6. Department of Thoracic Surgery, University of Rome SAPIENZA, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy

    Federico Venuta

  7. Division of Thoracic Surgery, S. Andrea Hospital, University of Rome SAPIENZA, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy

    Erino A. Rendina

  8. Department of Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy

    Pierluigi M. Granone

  9. Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy

    Piero Zannini

  10. Thoracic Surgery Unit, V. Fazzi Hospital, Lecce, Italy

    Gaetano Di Rienzo

  11. Thoracic Surgery Unit, Cannizzaro Hospital, Catania, Italy

    Maurizio Nicolosi

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  1. Giovanni Leuzzi
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  2. Filippo Lococo
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  6. Federico Venuta
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  8. Pierluigi M. Granone
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  9. Cristian Rapicetta
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  12. Maurizio Nicolosi
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  13. Francesco Facciolo
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Correspondence to Filippo Lococo.

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Leuzzi, G., Lococo, F., Alessandrini, G. et al. Prognostic Impact of Node-Spreading Pattern in Surgically Treated Small-Cell Lung Cancer: A Multicentric Analysis. Lung 195, 107–114 (2017). https://doi.org/10.1007/s00408-016-9954-4

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  • DOI: https://doi.org/10.1007/s00408-016-9954-4

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