title: Resected pN1 non-small cell lung cancer: recurrence patterns and nodal risk factors may suggest selection criteria for post-operative radiotherapy.
abstract: OBJECTIVE
  To describe the pattern of recurrence in resected pN1 non-small cell lung cancer (NSCLC) and to identify factors predicting an increased risk of locoregional recurrence (LR) or distant metastasis (DM) to define a selected population who may benefit from postoperative radiotherapy (PORT).
  
  
  METHODS
  285 patients with resected pN1 NSCLC were identified. Patients with positive surgical margins, undergoing neoadjuvant treatment or PORT, were excluded. LR was defined as first event of recurrence at the surgical bed, ipsilateral hilum or mediastinum, and other sites were considered as DM. Kaplan-Meier actuarial estimates of overall survival (OS), progression-free survival (PFS), freedom from LR (FFLR) and freedom from DM (FFDM) in different subgroups were compared with the log-rank test. Multivariate analysis was calculated.
  
  
  RESULTS
  202 patients met the inclusion criteria, 24 % received adjuvant chemotherapy. The median follow-up was 39 months. The total number of recurrences was 118 (64.4 %): 44 (24 %) and 74 (40.4 %) for LR and DM, respectively. Five-year OS and PFS rates were 39.2 and 33.3 %, respectively. Extra capsular extension (ECE) (RR 2.10, p = 0.01) and lymph nodal ratio (LNR) >0:15 (RR 1.68, p = 0.015) were associated with a worse PFS. ECE and LNR >0.15 were significantly related to a worst FFLR (RR 3.04 and 4.42, respectively), and adenocarcinoma to an unfavorable FFDM (RR 1.97, p = 0.013).
  
  
  CONCLUSIONS
  Nodal factors as high LNR and ECE can predict an increased risk of worse FFLR and PFS. Prospective data on selected patients, treated with modern radiotherapy techniques, need to be collected to re-evaluate the role of radiotherapy.
authors.affiliation: Department of Radiation Oncology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25124, Brescia, Italy. paolobor82@yahoo.it7.
authors.forename: Paolo
authors.initials: P
authors.lastname: Borghetti
authors.affiliation: Department of Radiation Oncology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25124, Brescia, Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: Barbera
authors.affiliation: Department of Radiation Oncology, Brescia University, Brescia, Italy.
authors.forename: Marco Lorenzo
authors.initials: ML
authors.lastname: Bonù
authors.affiliation: Department of Radiation Oncology, Brescia University, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Trevisan
authors.affiliation: Department of Radiation Oncology, Brescia University, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciccarelli
authors.affiliation: Department of Radiation Oncology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25124, Brescia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Vitali
authors.affiliation: Department of Radiation Oncology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25124, Brescia, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Maddalo
authors.affiliation: Department of Radiation Oncology, Brescia University, Brescia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Triggiani
authors.affiliation: Department of Radiation Oncology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25124, Brescia, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Pasinetti
authors.affiliation: Department of Radiation Oncology, Brescia University, Brescia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pedretti
authors.affiliation: Department of Radiation Oncology, Spedali Civili of Brescia, P.le Spedali Civili 1, 25124, Brescia, Italy.
authors.forename: Bartolomea
authors.initials: B
authors.lastname: Bonetti
authors.affiliation: Department of Thoracic Surgery, Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pariscenti
authors.affiliation: Department of Pathology, Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tironi
authors.affiliation: Department of Pneumology, Spedali Civili of Brescia, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Caprioli
authors.affiliation: Department of Radiation Oncology, Brescia University, Brescia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Department of Radiation Oncology, Brescia University, Brescia, Italy.
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Distant metastasis; Extra capsular extension; Locoregional recurrence; Lymph node ratio; Non-small cell lung cancer; Pathologic N1