Samanta Nicosia

Objectives: Lung cancer is the leading cause of cancer-related deaths worldwide and mediastinal lymph node involvement is an important negative prognostic factor. Nevertheless, the involvement of a single mediastinal nodal zone has been reported to have favorable outcomes. This study aims to assess whether the prognosis of non-small-cell lung cancer (NSCLC) with single-zone lymph node involvement varies by the affected lymph node zone. Methods: We retrospectively analyzed patients affected by NSCLC with a single lymph node zone involvement who underwent anatomical resection. The prognosis of patients was statistically compared based on the different affected lymph node zones. Results: A total of 135 patients were enrolled. All patients underwent anatomical lung resection and systematic lymph node dissection. Lymph node involvement was observed in 50 cases (37%) for the upper zone, 36 cases (27%) for the aorto-pulmonary (AP) zone, 41 cases (30%) for the subcarinal zone and 8 cases (6%) for the lower zone. The median follow-up was 37 months [ranging from 1 to 115 months]. Cancer recurrence was reported in 64 cases (52%) during this period. The 2-year and 4-year overall survival (OS) were 69% and 49%, respectively. The 2-year and 4-year relapse-free survival (RFS) were 55% and 41%. The OS and RFS change relating to the different involved lymph node zones (p < 0.01). Lower zone involvement predicts worse prognosis, upper zone and subcarinal zone better outcomes, and the AP zone involvement intermediate survival. Conclusions: The location of the affected lymph nodes appears to be an important prognostic factor in patients with NSCLC, with significant impacts on both OS and RFS. It may play a key role in the disease progression and patient survival by providing more personalized therapy.

Background: A prognostic score including T-dimension, age, histology and lymph node ratio was previously proposed in absence of an external validation dataset. The aim of the current study was to validate the proposed prognostic score using an independent dataset. Methods: Data of patients with lung carcinoids, who underwent surgical resection and lymphadenectomy in five institutions from 1 January 2005 to 31 December 2019, were retrospectively analyzed. Two risk groups were created based on the following data: age, histology, node ratio and pT for disease-free survival (DFS); age, sex, node ratio and pT for overall survival (OS). The previously proposed score was validated, identifying two groups of patients: a high risk (HRG) and low risk (LRG) group. Results: The final analysis was conducted on 283 patients. Regarding DFS, 230 (81.3%) patients were assigned to the LRG and 53 (18.7%) to the HRG. Considering OS, 268 (94.7%) were allocated in the LRG and 15 (5.3%) in the HRG. The 5-year DFS was 92.7% in the LRG vs. 67% in the HRG (p < 0.001) while the 5-year OS was 93.6% in the LRG vs. 86.2% in the HRG (p = 0.29) with clear curve separation. Conclusion: Our analysis confirmed the validity of the composite score for DFS in lung carcinoids. Regarding OS, statistical significance was not reached because of a low number of deaths and patients in the HRG.