Factors determining survival in resected N2 lung cancer

Abstract

This retrospective study was based on 237 patients with non-small cell lung cancer (NSCLC) and nodal N2 disease. All accessible mediastinal lymph nodes (LN) were removed and classified according to their anatomical location in LN chains. The pulmonary resections performed were: pneumonectomy (n = 187), lobectomy (n = 44) and segmentectomy (n = 4). There was solitary nodal chain involvement by metastasis in 141 cases, two chains in 72 cases and three or more in 24; "skip" metastases were present in 26.6%. N2 disease would have been missed in 45 cases of single chain involvement (31.9%) if routine removal of mediastinal nodes had not been performed. The overall 5-year survival rate was 18.8%. Survival was not influenced by site, size or extension (T) of tumor, tumor histology or the presence of vascular invasion. The prognosis was significantly worsened by the presence of microscopic residual disease (30 cases) and of satellite nodules (23 cases). Survival was significantly improved when metastases involved a single LN chain (26.3 versus 8.3%, P = 0.0003). The location and number of involved nodes in the chain, "skip" metastases and the presence of extracapsular spread of carcinoma did not influence the prognosis. Routine mediastinal LN dissection is necessary to improve survival and for classification of lung cancer. Anatomic description allows better understanding of N2 disease which is not a contraindication to surgery when a gross complete resection can be achieved.

Five-year survivors with resected PN2 nonsmall cell lung carcinoma

“…3,4,6 However, some pN2 patients survived Ͼ 5 years. Such patients would be good candidates for surgical resection and they are expected to have a better prognosis.…”

The Effect of the Isolated Aorticopulmonary Lymph Node on Survival in Lung Cancer

“…Similarly, it was also asserted that no difference was identified between single N2 and multi N2 in terms of the survey. Riquet et al [13], also suggested that distribution of metastatic mediastinal limp nodes is not important for the prognosis. However, there are some studies reporting that prognosis is worse in patients with N2 positivity compared to patients with single N2 positivity [12,14].…”

Survival Analysis in N2 (+) Patients for Whom Surgical Resection Was Performed

“…It was determined that survival in between 19% and 45% in various series (2,4,7). Presence of multiple N2 metastases has been defined as a negatively influencing factor for prognosis in many series (4,12,13 (14). In staging study of IASLC, when relationship of lymph node involvement with survival was investigated, survival was determined to be much better in cases with single-region metastasis (median 35 months) compared to the ones with multiple-region metastasis (median 19 months) (15).…”