Spanish Lung Cancer Group SCAT trial: surgical audit to lymph node assessment based on IASLC recommendations

The nomogram for the prediction of overall survival after surgery in patients in early-stage NSCLC based on SEER database and external validation cohort

BACKGROUND & AIMS

Currently, there is a lack of effective tools for predicting the prognostic outcome of early-stage lung cancer after surgery. We aim to create a nomogram model to help clinicians assess the risk of postoperative recurrence or metastasis.

MATERIALS AND METHODS

This work obtained 16,459 NSCLC patients based on SEER database from 2010 to 2015. In addition, we also enrolled 385 NSCLC patients (2017/01-2019/06) into external validation cohort at Tianjin Medical University General Hospital. Univariable as well as multivariable Cox regression was carried out for identifying factors independently predicting OS. In addition, we built a nomogram by incorporating the above prognostic factors for the prediction of OS.

RESULTS

Tumor size was positively correlated with the risk of poor differentiation. Advanced age, male and adenocarcinoma patients were factors independently predicting poor prognosis. The risk of white race is higher, followed by Black race, Asians and Indians, which is consistent with previous study. Chemotherapy is negatively related to prognostic outcome in patients of Stage IA NSCLC and positively related to that in those of Stage IB NSCLC. Lymph node dissection can reduce the postoperative mortality of patients. AUCs of the nomograms for 1, 2, and 3-year OS was 0.705, 0.712, and 0.714 for training cohort, while those were 0.684, 0.688, and 0.688 for validation cohort.

CONCLUSIONS

The nomogram could be used as a tool to predict the postoperative prognosis of patients with Stage I non-small cell lung cancer.

The absence of lymph nodes removed (pNx status) impacts survival in patients with lung cancer treated surgically

OBJECTIVES

We aimed to study the clinical significance of the lack of lymph node assessment (pNx status) and its impact on survival in non-small-cell lung cancer patients.

METHODS

We retrospectively analysed the Polish Lung Cancer Study Group database. pNx status was defined as 0 lymph nodes removed. We included 17,192 patients.

RESULTS

A total of 1080 patients (6%) had pNx status. pNx patients were more likely to be younger, be female, have a different pT distribution, have squamous cell carcinoma, undergo open thoracotomy, be operated on in non-academic hospitals, and have a lower rate of some comorbidities. pNx was more likely to be cN0 than pN1 and pN2 but less likely than pN0 (p < 0.001). pNx patients were less likely to undergo preoperative invasive mediastinal diagnostics than pN1 and pN2 patients but more likely than pN0 patients (p < 0.001). Overall, the five-year overall survival rates were 64%, 45%, 32% and 50% for pN0, pN1, pN2 and pNx, respectively. In pairwise comparisons, all pN descriptors differed significantly from each other (all p < 0.0001 but pNx vs. pN1 p = 0.016). The placement of the pNx survival curve and survival rate depended on histopathology, surgical approach and pT status. In multivariable analysis, pNx was an independent prognostic risk factor (HR = 1.37, 95%CI: 1.23-1.51, p < 0.01).

CONCLUSION

The resection of lymph nodes in lung cancer remains a crucial step in the surgical treatment of this disease. The survival of pNx patients is similar to that of pN1 patients. pNx survival curve placement depends on the other variables which could be useful in clinical decisions.

Prognostic factors of T2aN0M0 (T3-4cmN0M0, stage IB) non-small-cell lung cancer after surgery: Single-center real-world research

Aim

To further elucidate the prognostic factors of non‐small‐cell lung cancer (NSCLC) patients with T2aN0M0 (stage IB) who underwent surgical treatment.

Methods

We retrospectively analyzed the data of stage IB NSCLC patients who underwent surgical treatment at our center from October 2013 to September 2016. Eighty patients were enrolled. We analyzed their overall survival (OS) and disease‐free survival (DFS) using the Kaplan–Meier method.

Results

In univariable analysis, adenosquamous carcinoma (ASC) was significantly associated with inferior DFS (p = 0.036, p = 0.037) and OS (p = 0.001, p = 0.003) in all stage IB patients and those who only accepted surgery. Patients with a number of N2 lymph node dissections of ≥3 regions (N2‐LSNDr) exhibited better DFS (p = 0.020, p = 0.005) and OS (p = 0.003, p = 0.001) in all stage IB patients and those who only accepted surgery. In addition, advanced age (≥70 years old) is an adverse factor for DFS (p = 0.049) and OS (p = 0.018) among patients who did not receive adjuvant chemotherapy following surgery. In multivariable analyses, patients with N2‐LSNDr exhibited a longer OS (p = 0.045) in all enrolled patients; patients with N2‐LSNDr (p = 0.016) and younger age (p = 0.021) demonstrated a superior OS in patients who only received surgery.

Conclusions

We found that N2‐LSNDr were independent influencing factors affecting the prognosis in all included stage IB patients and stage IB patients without adjuvant chemotherapy. ASC was associated with worse prognosis of T2aN0M0 NSCLC. Older age is an independent prognostic factor of the worst OS in stage IB patients without adjuvant chemotherapy.