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 Angelo; Granone, Pierluigi; Rapicetta, Cristian; Zannini, Piero; Rienzo, Gaetano Di; Nicolosi, Maria Luisa; Facciolo, Francesco

doi:10.1007/s00408-016-9954-4

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…The male had worse survival than the female, which was consistent with the studies of Wang et al and Xiao et al [20,21]. Lymph nodes metastatic ratio, as a new meaningful indicator for OS of SCLC, was also recognized as an independent predictor [22,25]. The ones with lymph nodes resection performed had better survival than who not, which suggested to conduct lymphadenectomy for resectable SCLC.…”

Section: Discussionsupporting

confidence: 86%

“…By COX regression analyses, we identified age, sex, T stage, N stage, LNR, surgery and chemotherapy as independent predictors of overall survival. Some of these variables have been studied in previous research for their influence on survival of SCLC [12,[23][24][25][26]. Elder patients had worse survival than the younger ones might because degenerative changes in various aspects of organs function and increased prevalence of all types of comorbidities [27].…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a prognostic model of resectable small-cell lung cancer: a large population-based cohort study and external validation

et al. 2020

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Background: Survival outcomes of patients with resected SCLC differ widely. The aim of our study was to build a model for individualized risk assessment and accurate prediction of overall survival (OS) in resectable SCLC patients. Methods: We collected 1052 patients with resected SCLC from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were selected by COX regression analyses, based on which a nomogram was constructed by R code. External validation were performed in 114 patients from Shandong Provincial Hospital. We conducted comparison between the new model and the AJCC staging system. Kaplan-Meier survival analyses were applied to test the application of the risk stratification system. Results: Sex, age, T stage, N stage, LNR, surgery and chemotherapy were identified to be independent predictors of OS, according which a nomogram was built. Concordance index (C-index) of the training cohort were 0.721, 0.708, 0.726 for 1-, 3-and 5-year OS, respectively. And that in the validation cohort were 0.819, 0.656, 0.708, respectively. Calibration curves also showed great prediction accuracy. In comparison with 8th AJCC staging system, improved net benefits in decision curve analyses (DCA) and evaluated integrated discrimination improvement (IDI) were obtained. The risk stratification system can significantly distinguish the ones with different survival risk. We implemented the nomogram in a user-friendly webserver. Conclusions: We built a novel nomogram and risk stratification system integrating clinicopathological characteristics and surgical procedure for resectable SCLC. The model showed superior prediction ability for resectable SCLC.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Development and validation of a prognostic model of resectable small-cell lung cancer: a large population-based cohort study and external validation

et al. 2020

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“…Retrospective studies have reported favorable outcomes for surgery in patients with stage I SCLC 22,23. A growing number of patients with early stage SCLC receive surgical treatment, resulting in a favorable overall median survival of 29–91 months 24–27. The present study evaluated the survival outcomes of surgery versus non-surgery in patients with early stage SCLC, finding that surgery resulted in a better LCSS than that of non-surgery.…”

Section: Discussionmentioning

confidence: 84%

<p>Role of surgery in patients with early stage small-cell lung cancer</p>

Peng¹,

Li²,

Xiong³

et al. 2019

CMAR

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Purpose Currently, systemic chemotherapy combined with thoracic radiation is the standard treatment for patients with small-cell lung cancer (SCLC). However, the treatment of early stage SCLC remains controversial. This study evaluated the survival outcomes of surgical treatments and the effect of adjuvant chemotherapy and radiotherapy on lung cancer-specific survival (LCSS) in patients with early stage SCLC. Methods Using the Surveillance, Epidemiology, and End Results registry, we identified 2,453 patients with early stage SCLC (1,295 women and 1,158 men) who had complete clinical information between 2004 and 2015. The Kaplan-Meier analysis was used to determine the propensity score based on the characteristics of patients with early stage SCLC. LCSS was compared between patients treated with surgery and non-surgery after adjusting, stratifying, or matching patients with early stage SCLC. In addition, we compared the effects of chemotherapy and radiotherapy on LCSS in patients with early stage SCLC. Results Overall, 687 (28.0%) and 1,766 (72.0%) patients with early stage SCLC did and did not undergo surgery, respectively. Kaplan-Meier analysis demonstrated a statistically significant difference in survival curves between the surgery and non-surgery groups (log-rank p <0.001). Compared with the non-surgery group, the LCSS of the surgery group was better (hazard ratio [HR]:0.494, 95% confidence interval [CI]:0.415–0.587, p <0.001) in patients with early stage SCLC when using a Cox model for multivariate analysis. There was no statistically significant difference ( p =0.847) in LCSS between patients with early stage SCLC with and without chemotherapy in the multivariate analysis. Radiotherapy had favorable effects on LCSS (HR: 0.579, 95% CI: 0.500–0.671, p <0.001) in patients with early stage SCLC using multivariate analysis. Conclusions Our study results suggest that LCSS conferred by surgery was higher than that conferred by non-surgery and that radiotherapy is associated with better survival in patients with early stage SCLC. This study findings should be confirmed in prospective studies.

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“…In resected pN2 NSCLC, several studies have suggested an increased survival for skip metastases [14–17]; however, other reports with contradictory findings also exist [7, 18, 19]. In SCLC, Leuzzi et al [20] found N0 N2-patients showed a worse cancer-specific survival compared to patients with combined N1 N2-involvement (N0 N2 [8 months] versus N1 N2 [22 months]; p = 0.04). Our data showed no statistically significant difference in survival between patients with skip and non-skip N2 metastases.…”

Section: Discussionmentioning

confidence: 99%

Prediction of lymph node status in completely resected IIIa/N2 small cell lung cancer: importance of subcarinal station metastases

Qiao

Zhong

et al. 2019

J Cardiothorac Surg

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Background The aim of this study was to determine the prognostic value of lymph node status in patients with pathologic N2 (pN2) stage IIIA small cell lung cancer (SCLC). Methods A total of 163 consecutive pN2 stage IIIA SCLC patients who underwent pulmonary resections and systematic lymphadenectomies at Shanghai Chest Hospital between January 2006 and June 2014 were enrolled. We retrospectively analyzed the potential clinicopathologic factors that influenced survival, including the node levels (single or multiple-station) and the node-spreading patterns (skip N2 or non-skip N2). The prognostic significance was examined by Cox regression analysis. Results The median overall survival (OS) was 23.7 months. Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement ( p = 0.003). Skip metastasis did not appear to influence survival ( p = 0.099). With respect to the station of lymph node metastasis, the OS was only related to the involvement of the subcarinal node, regardless of tumor location ( p < 0.05). Multivariate analysis showed two statistically significant risk factors for survival, including multiple-station lymph node and subcarinal node metastasis (hazard ratio [HR] = 1.76, 95% confidence interval [CI]:1.11–2.78, p = 0.015; HR = 1.61, 95% CI: 1.03–2.50, p = 0.036, respectively). Conclusions Multiple-station N2 metastasis and involvement of the subcarinal node predicted poor prognosis in pN2 stage IIIA SCLC patients, which may profoundly influence therapeutic decisions.

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

Abstract: In selected surgically treated SCLC, the long-term survival may be stratified according to the node-spreading pattern.

Cited by 7 publications

References 21 publications

Development and validation of a prognostic model of resectable small-cell lung cancer: a large population-based cohort study and external validation

Development and validation of a prognostic model of resectable small-cell lung cancer: a large population-based cohort study and external validation

<p>Role of surgery in patients with early stage small-cell lung cancer</p>

Prediction of lymph node status in completely resected IIIa/N2 small cell lung cancer: importance of subcarinal station metastases

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