Original articleGeneral thoracicResults of Initial Operations in Non–Small Cell Lung Cancer Patients With Single-Level N2 Disease
Section snippets
Patients
Among 1,751 primary non–small cell lung cancer patients who underwent operations at Kanazawa University Hospital between January 1981 and May 2004, 325 patients were diagnosed as having mediastinal nodal involvement after resection of the primary site with systematic nodal dissection of both the hilar and mediastinal lymph nodes. Of those with N2 disease, 94 patients (52 men and 42 women) with a median age of 67 years (range, 36 to 82 years) had single-level N2 disease. All of these 94 patients
Results
The upper lobe was more frequently the primary site in the skip-N2 group as compared with the non–skip-N2 group (p = 0.0041). There were no significant differences in sex, age, tumor size, location of the primary site (right versus left), histologic type, percentage of patients with postoperative adjuvant therapy (systemic chemotherapy with or without radiation therapy), pathologic stage (IIIA versus IIIB), or the number of patients with clinical N2 disease between the two groups (Table 1).
With
Comment
In the present study, a relatively regular distribution of the spread of mediastinal nodal metastasis was found in both the skip and non–skip groups. That is, if the primary tumor was located in the upper lobe, nodal metastasis was detected mainly in the upper mediastinal area, whereas in patients with the primary tumor in the left lower lobe, nodal involvement was detected frequently in the lower mediastinal area. However, 7 patients (19.4% of the patients in whom the primary site was located
References (32)
- et al.
Skip metastasis to the mediastinal nodes in non–small cell lung cancer
Ann Thorac Surg
(1996) - et al.
Prolonged survival in patients with resected non–small cell lung cancer and single-level N2 disease
J Thorac Cardiovasc Surg
(2004) - et al.
Skip mediastinal lymph node metastasis and lung cancera particular N2 subgroup with a better prognosis
Ann Thorac Surg
(2005) - et al.
Lymph node mapping and curability at various levels of metastasis in resected lung cancer
J Thorac Cardiovasc Surg
(1978) - et al.
Increased vascular endothelial growth factor and vascular endothelial growth factor-c expression and decreased nm23 expression associated with microdissemination in the lymph nodes in stage I non–small cell lung cancer
J Thorac Cardiovasc Surg
(2000) - et al.
Direct lymphatic drainage of lung segments to the mediastinal nodes
J Thorac Cardiovasc Surg
(1989) - et al.
Patterns of mediastinal metastases in bronchogenic carcinoma
Chest
(1986) - et al.
Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer
Ann Thorac Surg
(2000) - et al.
A novel method for sentinel lymph node mapping using magnetite in patients with non-small cell lung cancer
J Thorac Cardiovasc Surg
(2003) - et al.
Effect of radioisotope sentinel node mapping in patients with cT1N0M0 lung cancer
J Thorac Cardiovasc Surg
(2003)
Can tumor size be a guide for limited surgical intervention in patients with peripheral non-small cell lung cancer? Assessment from the point of view of nodal micrometastasis
J Thorac Cardiovasc Surg
VEGF and VEGF-Cspecific induction of angiogenesis and lymphangiogenesis in the differentiated avian chorioallantoic membrane
Dev Biol
A novel prognostic indicator for cutaneous melanoma metastasis and survival
Am J Pathol
Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi’s sarcoma and a subset of angiosarcoma
Mod Pathol
A new monoclonal antibody, D2-40, for detection of lymphatic invasion in primary tumors
Lab Invest
Prognostic significance of proliferative activity in pN2 non–small cell lung carcinomas and their mediastinal lymph node metastases
Ann Surg
Cited by (41)
Cancer of the Lung: Non-Small Cell Lung Cancer and Small Cell Lung Cancer
2019, Abeloff’s Clinical OncologyIs there a survival difference between single station and multi-station N2 disease in operated non-small cell lung cancer patients?
2015, Cancer Treatment CommunicationsCitation Excerpt :The incidence of pathological N2 following surgical resection and complete mediastinal lymph node dissection varies from 17.6% to 26.5% [12], and the incidence of N2 was found 13.8% in our series. The involvement of a single station and the involvement of the lymph nodes other than the subcarinal lymph node are from the good prognostic criteria in N2 patients [13–16]. Several studies have demonstrated that the multiple-lymph node metastasis is a poor prognostic factor [8,9,17–19].
Cancer of the Lung: Non-Small Cell Lung Cancer and Small Cell Lung Cancer
2013, Abeloff's Clinical Oncology: Fifth EditionPrognostic factors after complete resection of pN2 non-small cell lung cancer
2013, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Skip N2 metastasis is discontinuous spread of tumors to mediastinal lymph nodes without involvement of the hilar lymph nodes. The incidence of lymph node skipping has been reported to be approximately 30% (22%-50%),5,6,15,17-21,23 and that of our study (50.0%) was slightly higher than these previous reports, which was likely due to a bias resulting from the fact that 60% of our patients had cN0 tumors. Several studies have reported that patients with skip N2 metastasis showed better prognosis than those with nonskip N2 metastasis5,6,15,19; however, other reports with contradictory findings also exist.20,21
Impact of the 7th TNM staging lung cancer in surgery
2012, Journal of Infection and Public HealthCitation Excerpt :This well clear confusion with large nodal masses that transgress individual nodal stations. Areas of continuing controversy regarding the relationship between lymph nodes metastases and overall survival include: intranodal versus extranodal disease [22]; single versus multiple (either N1 or N2) lymph node station disease [23–30]; the specific sites of lymph node metastases in relationship to the location of the primary tumor [24,26,29]; the significance of skip metastases [23]; and the need for systematic lymph node dissection versus a less extensive lymph node sampling [31] especially for tumors less than 2 cm in size [32]. Analyses of the IASLC database suggested that left upper lobe tumors with skip metastases in the AP zone (levels 5 and 6) were associated with a more favorable prognosis than other N2 subsets.
Implications of New (Seventh) TNM Classification of Lung Cancer on General Radiologists-A Pictorial Review
2011, Current Problems in Diagnostic RadiologyCitation Excerpt :For reconciliation of the 2 systems, lymph nodes were grouped into different zones and then analyzed to evaluate the prognosis of single- vs multilevel N1 and N2 disease. Previous studies have shown that skip metastases and single-level N2 disease (Fig 12) are both associated with better survival rates than involvement of multiple N2 lymph node stations (Fig 13).13,18-24 IASLC also had similar findings whereby single zone N2 disease had a similar survival to patients with multiple zone N1 disease, but the numbers were not statistically significant to warrant change in nodal descriptors.9