Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

Abstract

BackgroundNon-small cell lung carcinoma (NSCLC) with ipsilateral and/or subcarinal mediastinal lymphatic spread (N2) is a heterogeneous disease. The role of surgical resection in patients with N2 NSCLC remains controversial and no survival-based definition of “resectable N2” exists. The purpose of this study is to evaluate the factors that potentially affect the survival of N2 NSCLC patients who receive surgical resection and to define “resectable N2” based on the survival benefits.MethodsData from the open Surveillance, Epidemiology, and End Results (SEER) database from the National Cancer Institute in the United States were used to construct a nomogram. Patients who received surgery between 2010 and 2015 for N2 NSCLC were included. Independent prognostic factors for survival identified through Cox regression analysis were used to create the nomogram. The C-index, receiver operating characteristics (ROC) analyses, calibration curves, and risk stratification were used to evaluate the nomogram. The nomogram was also validated using data from 222 patients from Peking Union Medical College Hospital (PUMCH). Furthermore, lung cancer–related deaths were compared using competitive risk analysis.ResultsIn total, 4267 patients were included in the SEER cohort. Male gender, old age, high T stage and grade, adenosquamous and squamous cell carcinoma, lower lobe and overlapping lesions, extended lobe or bilobectomy and pneumonectomy, no chemotherapy, radiation before and after surgery, positive number of lymph nodes, and lymph node ratio (LNR) were identified as independent risk factors for higher mortality. The nomogram was created using these parameters. The C-index was 0.665 (95% confidence interval (CI), 0.651-0.679) and 0.722 (95% CI, 0.620-0.824) in the SEER and PUMCH cohorts, respectively. The calibration curves showed satisfactory consistency between the predicted and actual survival status in both the SEER and PUMCH cohorts. Competitive risk analysis confirmed that the variables in the nomogram, except radiation, are risk factors for prognosis.Conclusions“Resectable N2” should be assessed by a multidisciplinary team. The novel nomogram developed in this study may help with clinical decision-making for this patient population.

Role of Pneumonectomy in T1–4N2M0 Non-Small Cell Lung Cancer: A Propensity Score Matching Analysis

“…Similar to a previous study ( 17 ), we conducted univariable and multivariable analysis and found that N2 patients who received pneumonectomy, who were diagnosed in 2010–2015, who were younger, who were female, with a non-white race, with a marital status other than separated/divorced/widowed, with upper lobe disease, with adenocarcinoma, with a higher differentiated degree, with a lower T classification, and who received chemotherapy or/and radiotherapy were significantly associated with better long-term outcome. Chemotherapy and radiotherapy have been proven to be effective for NSCLC patients.…”

“…analyzed 4,267 N2 patients in the SEER database and developed a nomogram for prognosis prediction. They demonstrated that a multidisciplinary team should decide whether or not to perform surgical resection in N2 patients ( 17 ). For N2 patients with a central giant mass or tumor involving the main bronchus or large blood vessels, pneumonectomy is the primary surgical technique for R0 resection, usually accompanied by neoadjuvant chemoradiotherapy or induction therapy ( 5 , 18 ).…”

A joint analytic framework towards the problem of survival curves crossing and the application in patients with NSCLC

“…Whereas in this study radiotherapy was found to shorten survival time in NSCLC patients with survival time >14 months. Another study also found radiotherapy before or after surgery was associated with a higher risk of death, the possible reason for this may be the large proportion of stage III and IV patients treated with radiotherapy, which affected the prognosis (27). In this study, it was also found that the proportion of distant stage in the patients with radiotherapy group (63.88%) was higher than that in the non-radiotherapy group (49.57%).…”

Construction and validation of a novel web-based nomogram for patients with lung cancer with bone metastasis: A real-world analysis based on the SEER database

“…The cancer-related data in the SEER Program were obtained from 18 population-based registries, covering approximately 26% of the US population. Compared with any single institution, the SEER database encompasses much more population-level cancer data based on the largest sample size worldwide (13)(14)(15)(16).…”