Prognostic impact of lymph node spreading pattern in N2 NSCLC patients

ABSTRACT

Background

One-third of non-small cell lung cancer (NSCLC) patients are diagnosed with locally advanced disease. Long-term survival in stage IIIA/B-N2 remains poor; this may also be due to lymph node spreading pattern. Therefore, we compared the overall survival of stage IIIA/B-N2 patients with superior mediastinal lymph nodes (SML) with infracarinal- or inferior mediastinal lymph nodes (IML) and with multilevel disease (MLD).

Research design and methods

One-, three-and five-year survival rates were measured. Kaplan-Meier curves and Cox proportional hazards model assessed survival and were used to identify prognostic factors.

Results

We reviewed data of stage IIIA/B-N2 patients (n = 129) who underwent surgery for NSCLC between 2012 and 2020. Patients with SML (n = 62) were compared to ILM (n = 37) and MLD (n = 30). SML patients showed significantly better one- (SML: 95.2% vs. IML: 78.6% vs. MLD: 69.4%, p = 0.03), three- (78.8% vs. 27.7 vs. 13.3%; p = <0.001) and five-year (61.1% vs. 17.1 vs. 3%; p < 0.001) survival rates, than IML and MLD patients. Kaplan-Meier curves showed prolonged overall survival for SML patients (log-rank SML, ILM, MLD p < 0.0001).

Conclusions

This study showed significantly better long-term survival of SML patients than IML and MLD patients. The long-term survival of ILM and MLD patients was equally poor.

KEYWORDS:

• Non-small cell lung cancer
• lymph nodes
• neoadjuvant chemoradiation therapy
• stage IIIA/B-N2

Acknowledgments

An abstract of this manuscript was submitted and accepted and was presented at the 36 EACTS Annual Meeting, 5-8 October 2022, in Milano, Italy. The presentation was scheduled for the 07/10/2022

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Author contribution statement

Conceptualization: Georg Schlachtenberger, Matthias Heldwein

Methodology: Georg Schlachtenberger, Katja Hoepker

Software: Andres Amorin, Fabian Doerr

Validation: Hruy Menghesha, Khosro Hekmat

Formal analysis: Georg Schlachtenberger, Fabian Doerr

Investigation: Georg Schlachtenbeger, Lars Hagmeyer, Katja Hoepker

Resources: Khosro Hekmat, Thorsten Wahlers

Data Curation: Hruy Menghesha, Fabian Doerr

Writing - Original Draft: Georg Schlachtenberger, Matthias Heldwein

Writing - Review & Editing: Katja Hoepker, Lars Hagmeyer, Thorsten Wahlers, Khosro Hekmat

Visualization: Andres Amorin, Hruy Menghesha

Supervision: Matthias Heldwein, Thorsten Wahlers, Khosro Hekmat

Project administration: Thorsten Wahlers, Khosro Hekmat

Additional information

Funding

The authors have no funding to report.