Preoperative identification of clinicopathological prognostic factors for relapse-free survival in clinical N1 non-small cell lung cancer: a retrospective single center-based study

Abstract

Background Given the difficulty in preoperatively diagnosing lymph node metastasis, patients with Stage I–III non-small cell lung cancer (NSCLC) are likely to be included in the clinical N1 (cN1) group. However, better treatment options might be selected through further stratification. This study aimed to identify preoperative clinicopathological prognostic and stratification factors for patients with cN1 NSCLC. Methods This retrospective study evaluated 60 patients who were diagnosed with NSCLC during 2004–2014. Clinical nodal status had been evaluated using routine chest computed tomography (CT) and/or positron emission tomography (PET). To avoid biasing the fluorodeoxyglucose uptake values based on inter-institution or inter-model differences, we used only two PET systems (one PET system and one PET/CT system). Relapse-free survival (RFS) and overall survival (OS) were the primary study outcomes. The maximum standardized uptake value (SUVmax) was calculated for each tumor and categorized as low or high based on the median value. Patient sex, age, histology, tumor size, and tumor markers were also assessed. Results Poor OS was associated with older age ( P = 0.0159) and high SUVmax values ( P = 0.0142). Poor RFS was associated with positive carcinoembryonic antigen (CEA) expression ( P = 0.0035) and high SUVmax values ( P = 0.015). Multivariate analyses confirmed that poor OS was independently predicted by older age (hazard ratio [HR] = 2.751, confidence interval [CI]: 1.300–5.822; P = 0.0081) and high SUVmax values (HR = 5.121, 95% CI: 1.759–14.910; P = 0.0027). Furthermore, poor RFS was independently predicted by positive CEA expression (HR = 2.376, 95% CI: 1.056–5.348; P = 0.0366) and high SUVmax values (HR = 2.789, 95% CI: 1.042–7.458; P = 0.0410). The primary tumor’s SUVmax value was also an independent prognostic factor for both OS and RFS. Conclusions For patients with cN1 NSCLC, preoperative prognosis and stratification might be performed based on CEA expression, age, and the primary tumor’s SUVmax value. To enhance the prognostic value of the primary tumor’s SUVmax value, minimizing bias between facilities and models could lead to a more accurate prognostication.

Prognostic Value of Combing Primary Tumor and Nodal Glycolytic–Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis

“…Regional lymph node metastasis is common in NSCLC patients without distant metastasis (M0 disease) and is associated with a worse survival prognosis [32]. Disease recurrence within 5 years after initial curative treatment occurs in over half of lung cancer patients with nodal metastasis, and these patients eventually die of recurrence [9,10,32]. The survival outcomes of M0 patients with regional nodal metastatic NSCLC vary widely, despite initial aggressive treatment [8,9,11].…”

“…ECOG was also a prognostic factor for OS. Age and performance status are associated with survival outcomes in lung cancer as well as other malignancies, such as aerodigestive tract and gynecologic cancers [10,[43][44][45][46]. The aged population has more medical comorbidities.…”

“…Despite the current therapeutic advances, treatment responses and survival times in nodal metastatic NSCLC patients are quite heterogeneous, and a reliable prognostic model for this patient group is still lacking [9][10][11]. For selected patients, salvage surgery for persistent or recurrent disease has been shown to improve disease control and may improve OS [52,53].…”

“…However, the treatment response and survival outcome of NSCLC cases with regional nodal metastasis are quite heterogeneous. The 5 year overall survival (OS) rates range from 9% to 60% [8][9][10][11]. Furthermore, the nodal classification in the eighth edition of the American Joint Committee on Cancer (AJCC) may be inadequate for prognostic stratification of NSCLC cases with regional lymph node metastasis [11][12][13].…”

A comparison of 18F-FDG PET-based radiomics and deep learning in predicting regional lymph node metastasis in patients with resectable lung adenocarcinoma: a cross-scanner and temporal validation study

“…The 5-year disease-free survival rates reportedly range from 26.7 to 50% in lung cancer patients with pN + . In contrast, over 60% (60.1-90.8%) of patients may remain disease-free in those without pN+ [45,46]. Current clinical practice uses non-invasive imaging modalities such as 18 F-FDG PET to predict pN+ [3].…”