A novel clinical prognostic score incorporating the number of resected lymph-nodes to predict recurrence and survival in non-small-cell lung cancer.
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.
Bria
Emilio
E
Department of Medical Oncology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy. emiliobria@yahoo.it
Milella
Michele
M
Sperduti
Isabella
I
Alessandrini
Gabriele
G
Visca
Paolo
P
Corzani
Felicita
F
Giannarelli
Diana
D
Cerasoli
Virna
V
Cuppone
Federica
F
Cecere
Fabiana Letizia
FL
Marchetti
Antonio
A
Sacco
Rocco
R
Mucilli
Felice
F
Malatesta
Sara
S
Guetti
Luigi
L
Vitale
Luca
L
Ceribelli
Anna
A
Rinaldi
Massimo
M
Terzoli
Edmondo
E
Cognetti
Francesco
F
Facciolo
Francesco
F