A novel clinical prognostic score incorporating the number of resected lymph-nodes to predict recurrence and survival in non-small-cell lung cancer

Bria, Emilio; Milella, Michele; Sperduti, Isabella; Alessandrini, Gabriele; Visca, Paolo; Corzani, Felicita; Giannarelli, Diana; Cerasoli, Virna; Cuppone, Federica; Cecere, Fabiana Letizia; Marchetti, Antonio; Sacco, Rocco; Mucilli, Felice; Malatesta, Sara; Guetti, Luigi; Vitale, Luca; Ceribelli, Anna; Rinaldi, Massimo; Terzoli, Edmondo; Cognetti, Francesco; Facciolo, Francesco

doi:10.1016/j.lungcan.2009.02.024

« Previous Next »Lung Cancer
Volume 66, Issue 3 , Pages 365-371, December 2009

A novel clinical prognostic score incorporating the number of resected lymph-nodes to predict recurrence and survival in non-small-cell lung cancer☆

Emilio Bria
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
- Both authors (E.B. & M.M.) equally contributed to this work.
- Corresponding author. Tel.: +390652666132; fax: +390652666219.
Michele Milella
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
- Both authors (E.B. & M.M.) equally contributed to this work.
Isabella Sperduti
- Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
Gabriele Alessandrini
- Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy
Paolo Visca
- Pathology, Regina Elena National Cancer Institute, Rome, Italy
Felicita Corzani
- Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
Diana Giannarelli
- Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
Virna Cerasoli
- Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
Federica Cuppone
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Fabiana Letizia Cecere
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Antonio Marchetti
- Clinical Research Center, Center of Excellence on Aging, University-Foundation, Chieti, Italy
Rocco Sacco
- Department of Surgery, University of Chieti, Italy
Felice Mucilli
- Department of Surgery, University of Chieti, Italy
Sara Malatesta
- Clinical Research Center, Center of Excellence on Aging, University-Foundation, Chieti, Italy
Luigi Guetti
- Department of Surgery, University of Chieti, Italy
Luca Vitale
- Department of Surgery, University of Chieti, Italy
Anna Ceribelli
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Massimo Rinaldi
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Edmondo Terzoli
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Francesco Cognetti
- Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
Francesco Facciolo
- Thoracic Surgery, Regina Elena National Cancer Institute, Rome, Italy

Received 28 December 2008; received in revised form 5 February 2009; accepted 25 February 2009. published online 31 March 2009.

Abstract

Background

The number of resected lymph-nodes (#RNs) has proven prognostic in breast and colorectal cancer. Here we evaluated its prognostic impact in a series of resected NSCLC patients.

Methods

A panel of established prognostic factors plus (1) #RNs or (2) the ratio between the number of metastatic nodes and #RNs (NR) were correlated to overall- (OS), cancer-specific- (CSS), and disease-free-survival (DFS), using the Cox-model. Risk-classes according to hazard ratios (HR) were generated. Internal and external validation was accomplished.

Results

A dataset of 415 resected NSCLC patients was retrieved. At multivariate analysis, #RNs and NR were independent factor for longer OS, CSS and DFS (p<0.0001). Patients with a #RNs>10 (identified optimal cut-off) had a statistically significant OS (p=0.02) and DFS (p=0.0005) benefit. In node-positive patients, a NR<9% significantly correlated with better outcome. Stratification into High-, Medium-, and Low-Risk classes, based on High- (HRFs: stage, N-status, age, #RNs) and Intermediate-Risk Factors (IRFs: sex, grading, histology), efficiently predicted outcomes (p<0.0001). The risk class model performance was externally validated in and independent dataset of 297 patients.

Conclusions

These results contribute to complete the panel of prognostic factors for resected NSCLC. A prospective larger validation and comparison with molecular prognostic tools is warranted.

Keywords: Lymph-nodes, Lung cancer, Prognosis, Early-stage, Classification, Survival, Surgery