Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Long Term Survival of Patients with Unsuspected N2 Disease in Non-Small Cell Lung Cancer

  • Lee, Deok Heon (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Jae Bum (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Keum, Dong Yoon (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Hwang, Ilseon (Department of Pathology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Park, Chang Kwon (Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
  • Received : 2012.05.18
  • Accepted : 2012.08.29
  • Published : 2013.02.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The aim of this study was to determine the survival rate of patients with non-small cell lung cancer (NSCLC) who were preoperatively diagnosed with a negative N2 lymph node, but postoperatively confirmed as a positive N2 node based on a pathological evaluation. Materials and Methods: The hospital records of 248 patients from 1994 to 2009 with resected primary NSCLC who were preoperatively diagnosed with negative N2 lymph node, were retrospectively reviewed. Of these, after surgery, there were 148 (59.7%) patients with pathological N0, 54 (21.8%) with pathological N1 and 46 (18.5%) with pathological N2. Results: The median follow-up period was 24 months (range, 1 to 132 months). The 5-year disease free survival rates were 60% in pN0, 44% in pN1, and 29% in pN2. The 5-year overall survival rates were 63.1% in pN0, 51.9% in pN1, and 33.5% in pN2. There were no statistically significant differences between pN1 and pN2 (p=0.326 and p=0.106, respectively). Thirty-three (71.7%) of the 46 pN2 patients had single-zone metastasis, and 13 patients (28.3%) had multiple-zone metastases over the two nodal zone metastasis. There were no statistical differences in the 5-year disease free survival rate and the 5-year overall survival rates between the two groups. Conclusion: The 5-year disease free survival and the overall survival rate of the patients with unsuspected N2 disease were statistically similar with that of the patients with pathological N1 disease. There was no statistically significant difference between the patients with a single-zone metastasis and a multiple zone metastasis.

Keywords

References

  1. Robinson LA, Ruckdeschel JC, Wagner H Jr, Stevens CW; American College of Chest Physicians. Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132(3 Suppl): 243S-265S. https://doi.org/10.1378/chest.07-1379
  2. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
  3. Inoue M, Sawabata N, Takeda S, Ohta M, Ohno Y, Maeda H. Results of surgical intervention for p-stage IIIA (N2) non-small cell lung cancer: acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in the upper lobe. J Thorac Cardiovasc Surg 2004;127:1100-6. https://doi.org/10.1016/j.jtcvs.2003.09.012
  4. Keller SM, Vangel MG, Wagner H, et al. Prolonged survival in patients with resected non-small cell lung cancer and single-level N2 disease. J Thorac Cardiovasc Surg 2004;128: 130-7. https://doi.org/10.1016/j.jtcvs.2003.11.061
  5. Casali C, Stefani A, Natali P, Rossi G, Morandi U. Prognostic factors in surgically resected N2 non-small cell lung cancer: the importance of patterns of mediastinal lymph nodes metastases. Eur J Cardiothorac Surg 2005;28:33-8. https://doi.org/10.1016/j.ejcts.2005.03.016
  6. Fukui T, Mori S, Yokoi K, Mitsudomi T. Significance of the number of positive lymph nodes in resected non-small cell lung cancer. J Thorac Oncol 2006;1:120-5. https://doi.org/10.1097/01243894-200602000-00004
  7. Ohta Y, Shimizu Y, Minato H, Matsumoto I, Oda M, Watanabe G. Results of initial operations in non-small cell lung cancer patients with single-level N2 disease. Ann Thorac Surg 2006;81:427-33. https://doi.org/10.1016/j.athoracsur.2005.08.018
  8. Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg 2008;86:362-6. https://doi.org/10.1016/j.athoracsur.2008.04.042
  9. Lee JG, Lee CY, Park IK, et al. Number of metastatic lymph nodes in resected non-small cell lung cancer predicts patient survival. Ann Thorac Surg 2008;85:211-5. https://doi.org/10.1016/j.athoracsur.2007.08.020
  10. Misthos P, Sepsas E, Kokotsakis J, Skottis I, Lioulias A. The significance of one-station N2 disease in the prognosis of patients with nonsmall-cell lung cancer. Ann Thorac Surg 2008;86:1626-30. https://doi.org/10.1016/j.athoracsur.2008.07.076
  11. Kim DJ, Kim KD, Kim CY, Chung KY. Nodal station as a prognostic factor in resected stage IIIA N2 non-small cell lung cancer. Korean J Thorac Cardiovasc Surg 2003;36: 489-96.
  12. Rusch VW, Asamura H, Watanabe H, et al. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 2009;4: 568-77. https://doi.org/10.1097/JTO.0b013e3181a0d82e
  13. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997;111:1718-23. https://doi.org/10.1378/chest.111.6.1718
  14. Naruke T. The spread of lung cancer and its relevance to surgery. J Jpn Surg Soc 1967;68:1607-21.
  15. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:832-9.
  16. De Leyn P, Schoonooghe P, Deneffe G, et al. Surgery for non-small cell lung cancer with unsuspected metastasis to ipsilateral mediastinal or subcarinal nodes (N2 disease). Eur J Cardiothorac Surg 1996;10:649-54. https://doi.org/10.1016/S1010-7940(96)80380-0
  17. Kang CH, Ra YJ, Kim YT, Jheon SH, Sung SW, Kim JH. The impact of multiple metastatic nodal stations on survival in patients with resectable N1 and N2 nonsmall-cell lung cancer. Ann Thorac Surg 2008;86:1092-7. https://doi.org/10.1016/j.athoracsur.2008.06.056
  18. Nakagiri T, Sawabata N, Funaki S, et al. Validation of pN2 sub-classifications in patients with pathological stage IIIA N2 non-small cell lung cancer. Interact Cardiovasc Thorac Surg 2011;12:733-8. https://doi.org/10.1510/icvts.2010.249896
  19. Kim MS, Lee HS, Lee JM, Zo JI, Lee GK, Nam BH. Prognostic value of single nodal zone metastasis in non-smallcell lung cancer. Eur J Cardiothorac Surg 2010;38:491-7. https://doi.org/10.1016/j.ejcts.2010.02.033
  20. Takamochi K, Oh S, Suzuki K. Prognostic evaluation of nodal staging based on the new IASLC lymph node map for lung cancer. Thorac Cardiovasc Surg 2010;58:345-9. https://doi.org/10.1055/s-0030-1249944

Cited by

  1. The effects of radiotherapy on the survival of patients with unresectable non-small cell lung cancer vol.18, pp.6, 2018, https://doi.org/10.1080/14737140.2018.1458615
  2. MEDIASTinal staging of non-small cell lung cancer by endobronchial and endoscopic ultrasonography with or without additional surgical mediastinoscopy (MEDIASTrial): study protocol of a multicenter ran vol.18, pp.None, 2013, https://doi.org/10.1186/s12893-018-0359-6
  3. Preoperative Risk Factors for Pathologic N2 Metastasis in Positron Emission Tomography-Computed Tomography-Diagnosed N0-1 Non-Small Cell Lung Cancer vol.52, pp.4, 2013, https://doi.org/10.5090/kjtcs.2019.52.4.221
  4. Optimal Adjuvant Therapy in Resected Stage IIIA-N2 Non-Small-Cell Lung Cancer Harboring EGFR Mutations vol.43, pp.12, 2020, https://doi.org/10.1159/000506692