Survival Analysis in Single N2 Station Lung Adenocarcinoma: The Prognostic Role of Involved Lymph Nodes and Adjuvant Therapy

Abstract

Background: Prognostic factors in patients with single mediastinal station (sN2) involvement continues to be a debated issue. Methods: Data on 213 adenocarcinoma patients with sN2 involvement and who had undergone complete anatomical lung resection and lymphadenectomy, were retrospectively reviewed. Clinical and pathological characteristics together with adjuvant therapy (AD) and node (N) status classifications (number of resected nodes (#RN), number of metastatic nodes (#MN), and node ratio (#MN/#RN = NR) were analyzed. Results: Univariable analysis confirmed that age (0.009), #MN (0.009), NR (0.003), #N1 involved stations (p = 0.003), and skip metastases (p = 0.005) were related to overall survival (OS). Multivariable analysis confirmed, as independent prognostic factors, age <66 years and NR with a three-year OS (3YOS) of 78.7% in NR < 10% vs. 46.6% in NR > 10%. In skip metastases, NR (HR 2.734, 95% CI 1.417–5.277, p = 0.003) and pT stage (HR2.136, 95% CI 1.001–4.557, p = 0.050) were confirmed as independent prognostic factors. AD did not influence the OS of patients with singular positive lymph nodes (p = 0.41), while in patients with multiple lymph nodes and AD, a significantly better 3YOS was demonstrated, i.e., 49.1% vs. 30% (p = 0.004). In patients with N2 + N1 involvement, age (p = 0.002) and AD (p = 0.022) were favorable prognostic factors. Conclusions: Adenocarcinoma patients with single N2 station involvement had a favorable outcome in the case of skip metastases and low NR. Adjuvant therapy improves survival with multiple nodal involvement, while its role in single node involvement should be clarified.

Resection of calcified lymph nodes confers clinical benefit in patients with non‑small cell lung cancer

“…Preoperative evaluation of mediastinal lymph nodes (LNs) in patients with lung cancer is essential for determining optimal treatment strategies in the management of primary lung cancer. On the one hand, the status of mediastinal LNs metastasis can not only affects the formulation of perioperative diagnosis and treatment strategies (1)(2)(3), but also affects the survival time of patients after surgery (4)(5)(6). Therefore, the current National Comprehensive Cancer Network guidelines for non-small cell lung cancer (NSCLC) suggests that N1 (ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes) and N2 (ipsilateral mediastinal and/or subcarinal lymph node(s)) node resection and mapping should be a routine component of lung cancer resections with a minimum of three N2 stations sampled or complete lymph node dissection (7).…”