Prognostic Factors for Surgically Resected N2 Non-small Cell Lung Cancer

Abstract

Purpose: Non-small cell lung cancers (NSCLCs) with pathologically documented ipsilateral mediastinal lymph node (LN) metastases (pN2) are a broad spectrum of diseases. We retrospectively analyzed prognostic factors for cases of pN2 NSCLC treated by surgical resection. Methods: Clinicopathological data were reviewed for consecutive 121 patients who underwent anatomical pulmonary resection with mediastinal LN sampling or dissection for pN2 NSCLC over a 15-year period. Results: The 5-year survival rate for all patients was 29.9%. Clinical N status, curability, surgical procedure and adjuvant chemotherapy were favorable prognostic factors in univariate analysis, with 5-year survival rates of 35.0% for cN0/1 vs. 17.7% for cN2/3 cases; 33.1% for R0 vs. 14.7% for R1/2 resection; 31.5% for lobectomy vs. 25.0% for bilobectomy and 15.6% for pneumonectomy; and 72.7% with adjuvant chemotherapy vs. 23.8% without adjuvant chemotherapy. Survival did not differ significantly based on gender, age, smoking status, clinical T status, tumor location, histology, skip metastasis, subcarinal LN metastasis, or number of involved N2 levels. In multivariate analysis, adjuvant chemotherapy, R0 resection, and lobectomy emerged as independent favorable prognostic factors. Conclusion: Complete resection using lobectomy and adjuvant chemotherapy are favorable prognostic factors in cases of pN2 NSCLC.

Fisetin inhibits the growth and migration in the A549 human lung cancer cell line via the ERK1/2 pathway

“…The specific primer sequences are listed in Table I. MTT assay. A549 cells were seeded at a density of 3x10 4 cells/ml in a 24-well plate, cultured for 24 h and then treated with fisetin (0, 10, 20, 30 or 40 µM for 24, 48 or 72 h). The cell viability was analyzed using an MTT assay according to a previously described method (27).…”

“…However, >80% of NSCLC patients cannot be treated with surgery due to the high prevalence of metastasis (3). According to statistics, the 5-year survival rate after lung cancer diagnosis is only 17.7% (4). NSCLC commonly develops resistance to radiation and chemotherapy, and patients are often diagnosed at stages beyond surgical remedy (5).…”

Risk Prediction for Locoregional Recurrence in Epidermal Growth Factor Receptor-Mutant Stage III-pN2 Lung Adenocarcinoma after Complete Resection: A Multi-center Retrospective Study

“…[21] Unforeseen N2 reflects minimal mediastinal invasion and favorable survival. [22,23] In this subgroup, the addition of adjuvant radiotherapy to chemotherapy did not provide extra benefit compared with chemotherapy alone. [24] Minimal N2/single station was regarded as potentially resected cases proposed by the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines.…”

Risk factors of lobar lymph node metastases in non-primary tumor-bearing lobes among the patients of non-small-cell lung cancer

“…This group of unexpected mediastinal involvement disease is mostly a single-station mediastinal lymph node metastasis. Some literatures support single-station N2 metastasis as the first choice for surgical treatment [ 44 – 46 ]. Therefore, it is clinically feasible for this group of patients to continue to perform surgery and receive postoperative adjuvant chemotherapy.…”

“…With the latest guidelines, for some of the patients of this study, neoadjuvant chemo- and/or radiotherapy would be recommended. However, for the period of the reported study we took into account other reports (see for example [ 45 , 46 ]) which suggest that for cases with small primary tumor and absence of multi-station metastases, additional treatment may be omitted. For T3/T4 cases with N0/N1 status, we concluded that surgery was sufficient without preliminary treatment.…”