Results of Initial Operations in Non–Small Cell Lung Cancer Patients With Single-Level N2 Disease

doi:10.1016/j.athoracsur.2005.08.018

The Annals of Thoracic Surgery

Volume 81, Issue 2, February 2006, Pages 427-433

https://doi.org/10.1016/j.athoracsur.2005.08.018 Get rights and content

Background

There is still debate regarding the use of surgery in the management of non–small cell lung cancer patients with N2 disease. The primary aim of the present study was analysis of the results of initial operations in non–small cell lung cancer patients with single-level N2 disease.

Methods

Ninety-four patients with the disease who underwent initial surgery consisting of complete resection of the primary site plus systematic lymphadenectomy were examined. We also immunohistochemically examined lymphatic vessel density and vascular endothelial growth factor-C expression.

Results

The overall 5- and 10-year survival rates for the 94 patients were 27.1% and 12.1%, respectively, with a median survival of 22 months. When stratified by skipping status, the 5-year survival rates for the patients in skip-N2 and non–skip-N2 groups were 33.4% and 19.8%, respectively (p = 0.0189). Skip metastasis, T factor, subcarinal lymph node metastasis, and adjuvant chemotherapy were recognized as independent prognostic indicators. In both skip-N2 and non–skip-N2 groups, distant relapse was the dominant pattern of recurrence. Although the peritumoral lymphatic vessel density was associated with vascular endothelial growth factor-C expression in tumors, the lymphangiogenic profile appeared to be different between skip-N2 and non–skip-N2 tumors, suggesting different nodal metastatic process.

Conclusions

Lung cancer patients with single-level N2 disease are an oncologically heterogeneous cohort. Although further studies involving randomized comparisons are required, the poor outcomes found here indicate that the initial operation has yet to be validated for patients with this 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

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Increased pT classification signifies enhanced tumor invasiveness and/or tumor burden. Several studies in Japan also showed a prognostic significance of pT classification in cases of completely resected pN2 NSCLC,5,6,15 and our findings are highly corroborative with theirs. Extent of N2 metastasis was also revealed to be an independent prognostic factor affecting OS in our study.
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Original articleGeneral thoracicResults of Initial Operations in Non–Small Cell Lung Cancer Patients With Single-Level N2 Disease

Background

Methods

Results

Conclusions

Section snippets

Patients

Results

Comment

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Dev Biol

Am J Pathol

Mod Pathol

Lab Invest

Prognostic significance of proliferative activity in pN2 non–small cell lung carcinomas and their mediastinal lymph node metastases

Ann Surg

Original article
General thoracic
Results of Initial Operations in Non–Small Cell Lung Cancer Patients With Single-Level N2 Disease