Retrospective study of patients with pathologic N1-stage II non-small cell lung cancer

Abstract

The population of patients with N1-stage II disease is small among non-small cell lung cancer patients and there have been relatively few studies regarding prognostic factors for the disease. We retrospectively evaluated the clinicopathological features of the disease to identify prognostic factors. The clinical records of 85 patients with N1-stage II non-small cell lung cancer who underwent lobectomy or pneumonectomy with systematic lymph node dissection or sampling were retrospectively reviewed. The study population comprised 64 men and 21 women, among whom 49 had adenocarcinoma, six had squamous cell carcinoma and two had large cell carcinoma. The prognosis was significantly better for p0 vs. p2-3 disease (P=0.029), pneumonectomy vs. lobectomy (P=0.027) and direct extension vs. metastasis to N1 lymph nodes (P=0.015). On the other hand, there was no significant difference in survival regarding the number or level of the involved lymph node stations. A multivariate analysis for prognostic factors revealed that status of lymph node involvement as well as gender and pleural factor was a significant independent prognostic factor (P=0.026). Our results have revealed that direct extension to N1 lymph nodes is an independent favorable prognostic factor as opposed to metastasis for surgically-treated patients with N1-stage II disease.

The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer

“…[9][10][11] Research evaluating the number of positive LNs as a new prognostic factor in N1 NSCLC has shown confl icting results. 5,7,8,12,22 Using similar groupings as ours, Marra et al 7 found an association, in univariate but not in adjusted analysis, between the number of positive nodes and survival in a cohort of patients with resected N1 NSCLC from a single referral center.…”

“…A Japanese study also failed to fi nd a relationship between survival and the number of N1 LNs. 22 These studies were conducted among cases from single referral centers and, in general, included small numbers of patients. Additionally, some studies were conducted in heterogeneous populations (N1 and N2 disease) and did not control for the number of LNs sampled, factors that may explain the variability of other organ systems.…”

Risk Factors for Tumor Recurrence in Patients With Early-Stage (Stage I and II) Non-small Cell Lung Cancer

“…However, the reported 5-year survival rates of patients with stage I and II disease are approximately 60% to 90% and 30% to 70% after complete resection, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and not a few patients eventually die because of the disease. Although recent randomized controlled trials have shown a significant survival benefi t from cisplatin-based adjuvant chemotherapy for patients with NSCLC stage II or higher, 18,19 whether patients with stage I NSCLC should receive chemotherapy remains controversial.…”

N1 non-small-cell lung cancer. A 20-year surgical experience

“…20 The number of involved nodes and number of stations have also been recognized as significant predictors of survival. 3,4 In our series, multiple-node involvement was a poor prognostic indicator (5-year survival, 33%), as well as multiple-station metastases (5-year survival, 21%). The latter was confirmed on multivariate analysis.…”

“…Many reports have demonstrated the heterogeneous prognosis of resected N1 disease, and suggested revision of N1 descriptors to provide a more accurate prognostic stratification. [3][4][5][6][7][8] The main problems are difficulty in determining the exact anatomical location of each resected N1 node and the lack of a worldwide accepted lymph node map, preventing reliable comparison of results from different studies. Surgical series from Western countries adopted the Mountain and Dresler 9 modification of the American Thoracic Society lymph node map, while series from Japan were staged according to the Naruke lymph node map adopted by the Japan Lung Cancer Society.…”