La radiologia medica

, Volume 121, Issue 9, pp 696–703 | Cite as

Resected pN1 non-small cell lung cancer: recurrence patterns and nodal risk factors may suggest selection criteria for post-operative radiotherapy

  • Paolo BorghettiEmail author
  • Fernando Barbera
  • Marco Lorenzo Bonù
  • Francesca Trevisan
  • Stefano Ciccarelli
  • Paola Vitali
  • Marta Maddalo
  • Luca Triggiani
  • Nadia Pasinetti
  • Sara Pedretti
  • Bartolomea Bonetti
  • Gianluca Pariscenti
  • Andrea Tironi
  • Alberto Caprioli
  • Michela Buglione
  • Stefano Maria Magrini



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).


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.


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).


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.


Locoregional recurrence Distant metastasis Pathologic N1 Non-small cell lung cancer Extra capsular extension Lymph node ratio 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (retrospective study), formal consent is not required.


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Copyright information

© Italian Society of Medical Radiology 2016

Authors and Affiliations

  • Paolo Borghetti
    • 1
    Email author
  • Fernando Barbera
    • 1
  • Marco Lorenzo Bonù
    • 2
  • Francesca Trevisan
    • 2
  • Stefano Ciccarelli
    • 2
  • Paola Vitali
    • 1
  • Marta Maddalo
    • 1
  • Luca Triggiani
    • 2
  • Nadia Pasinetti
    • 1
  • Sara Pedretti
    • 2
  • Bartolomea Bonetti
    • 1
  • Gianluca Pariscenti
    • 3
  • Andrea Tironi
    • 4
  • Alberto Caprioli
    • 5
  • Michela Buglione
    • 2
  • Stefano Maria Magrini
    • 2
  1. 1.Department of Radiation OncologySpedali Civili of BresciaBresciaItaly
  2. 2.Department of Radiation OncologyBrescia UniversityBresciaItaly
  3. 3.Department of Thoracic SurgerySpedali Civili of BresciaBresciaItaly
  4. 4.Department of PathologySpedali Civili of BresciaBresciaItaly
  5. 5.Department of PneumologySpedali Civili of BresciaBresciaItaly

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