Prognostic Impact of Node-Spreading Pattern in Surgically Treated Small-Cell Lung Cancer: A Multicentric Analysis.
Lung
; 195(1): 107-114, 2017 02.
Article
en En
| MEDLINE
| ID: mdl-27738827
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Asunto principal:
Carcinoma de Pulmón de Células no Pequeñas
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Neoplasias Pulmonares
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Escisión del Ganglio Linfático
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Ganglios Linfáticos
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Lung
Año:
2017
Tipo del documento:
Article
País de afiliación:
Italia