Impact of Persistent N2 Disease and Lymph Node Ratio on Oncological Outcomes after Multimodal Treatment in Pre-Operative Histologically Proven N2 Disease Non-Small-Cell Lung Cancer

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Stefano Bongiolatti Francesca Mazzoni Alessandro Gonfiotti Alberto Salvicchi Domenico Viggiano Katia Ferrari Vieri Scotti Luca Voltolini

Corresponding Author

Alberto Salvicchi
Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy

A B S T R A C T

Objective: The objectives of our retrospective analysis were to estimate the oncological long-term results of patients with ypN2 and to evaluate the impact of lymph node ratio (LNR) on overall (OS) and disease-free survival (DFS). Methods: We analysed all consecutive patients (n=85) undergoing neoadjuvant chemotherapy (NAC) and surgery for pre-operative pathologically proven stage IIIA-B (N2) NSCLC from 2014 to 2020. Median LNR (0.29 or 29%) was selected as threshold for grouping. Survival was estimated using the Kaplan-Meier method. Cox regression was used to test the association between OS, DFS and covariates. Results: Post-operative mortality was 3.5%. The median follow-up was 21 months (range 6-69 months). The 5-year OS and DFS of the cohort were 41% and 20%. Patients with LNR>0.29 (n=13; 15.3%) showed a trend toward worse survival than patients with LNR0 (n=44; 51.8%) with a 5-year OS of 56% VS 14% (p=0.077), confirmed as a trend at the multivariable analysis (HR 2.28; p=0.066). At the univariate analysis a worse DFS was observed for ypN2 patients (n=58; 68.2%) compared with nodal downstaging (46% vs 25% 3-year DFS, p=0.039). DFS was different according to LNR: 3-year DFS was 14% in patients with LNR>0.29 while it reached 44% in patients with LNR 0 (p=0.043) and 62% in LNR<0.29 (p=0.03). LNR>0.29 was the only significant predictor (HR 2.89; p=0.047) of reduced DFS at the multivariable analysis. Conclusion: patients with ypN2 disease after NAC showed acceptable oncological outcomes and this finding is true for patients with low burden of nodal disease assessed by LNR.

Article Info

Article Type

Research Article

Publication history

Received: Mon 05, Apr 2021
Accepted: Mon 26, Apr 2021
Published: Mon 31, May 2021

Copyright

© 2023 Alberto Salvicchi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.COR.2021.05.03