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Thorac Cardiovasc Surg 2014; 62(02): 126-132
DOI: 10.1055/s-0033-1338132
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Analysis of Predictive Factors for Postoperative Survival for Non Small Cell Lung Carcinoma Patients with Unexpected Mediastinal Lymph Nodes Metastasis

Shaohua Wang
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
2   Department of Thoracic Surgery, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China
,
Wenyong Zhou
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
,
Hui Zhang
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
,
Mingchuan Zhao
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
,
Xiaofeng Chen
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
› Institutsangaben
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Publikationsverlauf

09. November 2012

06. Februar 2013

Publikationsdatum:
12. April 2013 (online)

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Abstract

Objectives To discuss the predictive factors of postoperative survival for non small cell lung carcinoma (NSCLC) patients with clinical N0 stage but postoperative pathological N2 stage (cN0–pN2).

Methods From January 1, 2005, to December 31, 2009, the clinical data of NSCLC patients with cN0–pN2 after radical surgery were retrospectively collected, and their survival information was collected through follow-up. The expiration date for follow-up was December 31, 2011. The predictive factors of postoperative survival for NSCLC patients with unexpected mediastinal lymph node metastasis were analyzed using Cox proportional hazards regression.

Results A total of 263 patients were enrolled. The follow-up rate was 91.63%. The overall 1-, 3-, and 5-year survival rates were 94.6, 55.2, and 26.3%, respectively. Video-assisted thoracotomy surgery (VATS; odds ratio [OR] 0.659; 95% confidence interval [CI] 0.469 to 0.927; p = 0.017), multiple stations of metastatic mediastinal lymph nodes (OR 1.605; 95% CI 1.180 to 2.183; p = 0.003), and no adjuvant chemotherapy (OR 1.576; 95% CI 1.105 to 2.246; p = 0.012) were independent predictive factors for unexpected N2 patients. The median survival after VATS was superior to that after thoracotomy for patients with a single station of metastatic mediastinal lymph node (48.45 m vs 37.34 m, p = 0.018). The median survival without any adjuvant chemotherapy was inferior to that after adjuvant chemotherapy for patients with multiple stations of metastatic mediastinal lymph nodes (20.32 m vs 31.55 m, p = 0.001).

Conclusion The postoperative survival for NSCLC patients with cN0–pN2 was related to operational method, adjuvant chemotherapy, and the number of metastatic mediastinal lymph node stations. Patients with a single station of metastatic mediastinal lymph node are likely to benefit from VATS, whereas patients with multiple stations of metastatic mediastinal lymph nodes are likely to benefit from adjuvant chemotherapy.

Keywords

non small cell lung cancer - staging - surgery - prognosis
 

  • References

  • 1 Decaluwé H, De Leyn P, Vansteenkiste J , et al. Surgical multimodality treatment for baseline resectable stage IIIA-N2 non-small cell lung cancer. Degree of mediastinal lymph node involvement and impact on survival. Eur J Cardiothorac Surg 2009; 36 (3) 433-439
    CrossrefPubMedGoogle Scholar
  • 2 Kim HK, Choi YS, Kim J, Shim YM, Kim K. Outcomes of unexpected pathologic N1 and N2 disease after video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 2010; 140 (6) 1288-1293
    CrossrefPubMedGoogle Scholar
  • 3 Iskender I, Kapicibasi HO, Kadioglu SZ , et al. Comparison of integrated positron emission tomography/computed tomography and mediastinoscopy in mediastinal staging of non-small cell lung cancer: analysis of 212 patients. Acta Chir Belg 2012; 112 (3) 219-225
    PubMedGoogle Scholar
  • 4 Lee BE, Kletsman E, Rutledge JR, Korst RJ. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2012; 143 (3) 585-590
    CrossrefPubMedGoogle Scholar
  • 5 Nakanishi R, Osaki T, Nakanishi K , et al. Treatment strategy for patients with surgically discovered N2 stage IIIA non-small cell lung cancer. Ann Thorac Surg 1997; 64 (2) 342-348
    CrossrefPubMedGoogle Scholar
  • 6 Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg 2008; 86 (2) 362-366 , discussion 366–367
    CrossrefPubMedGoogle Scholar
  • 7 Detterbeck F. What to do with “Surprise” N2?: intraoperative management of patients with non-small cell lung cancer. J Thorac Oncol 2008; 3 (3) 289-302
    CrossrefPubMedGoogle Scholar
  • 8 Lorent N, De Leyn P, Lievens Y , et al; Leuven Lung Cancer Group. Long-term survival of surgically staged IIIA-N2 non-small-cell lung cancer treated with surgical combined modality approach: analysis of a 7-year prospective experience. Ann Oncol 2004; 15 (11) 1645-1653
    CrossrefPubMedGoogle Scholar
  • 9 Riquet M, Hidden G, Debesse B. Direct lymphatic drainage of lung segments to the mediastinal nodes. An anatomic study on 260 adults. J Thorac Cardiovasc Surg 1989; 97 (4) 623-632
    PubMedGoogle Scholar
  • 10 Riquet M, Assouad J, Bagan P , et al. Skip mediastinal lymph node metastasis and lung cancer: a particular N2 subgroup with a better prognosis. Ann Thorac Surg 2005; 79 (1) 225-233
    CrossrefPubMedGoogle Scholar
  • 11 Junker K, Gumprich T, Müller KM. Diskontinuierliche Lymphknotenmetastasen (“skipping”) bei bösartigen Lungentumoren. [Discontinuous lymph node metastases (“skipping”) in malignant lung tumors]. Chirurg 1997; 68 (6) 596-599, discussion 600
    CrossrefPubMedGoogle Scholar
  • 12 Friedel G, Linder A, Pfeiffer S, Toomes H. Radical lung surgery interventions with special reference to lymphadenectomy. Langenbecks Arch Chir Suppl Kongressbd 1996; 113: 785-789
    PubMedGoogle Scholar
  • 13 Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 2000; 24 (1) 27-30 , discussion 30–31
    CrossrefPubMedGoogle Scholar
  • 14 Gabor S, Renner H, Popper H , et al. Invasion of blood vessels as significant prognostic factor in radically resected T1–3N0M0 non-small-cell lung cancer. Eur J Cardiothorac Surg 2008; 34 (4) 892-897
    CrossrefPubMedGoogle Scholar
  • 15 Maeda R, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. Prognostic impact of intratumoral vascular invasion in non-small cell lung cancer patients. Thorax 2010; 65 (12) 1092-1098
    CrossrefPubMedGoogle Scholar
  • 16 Lee AK, DeLellis RA, Silverman ML, Heatley GJ, Wolfe HJ. Prognostic significance of peritumoral lymphatic and blood vessel invasion in node-negative carcinoma of the breast. J Clin Oncol 1990; 8 (9) 1457-1465
    PubMedGoogle Scholar
  • 17 Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J. International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 2004; 350 (4) 351-360
    CrossrefPubMedGoogle Scholar
  • 18 Pignon J-P, Tribodet H, Scagliotti GV , et al; LACE Collaborative Group. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 2008; 26 (21) 3552-3559
    CrossrefPubMedGoogle Scholar
  • 19 Winton T, Livingston R, Johnson D , et al; National Cancer Institute of Canada Clinical Trials Group; National Cancer Institute of the United States Intergroup JBR.10 Trial Investigators. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 2005; 352 (25) 2589-2597
    CrossrefPubMedGoogle Scholar
  • 20 Waller D, Peake MD, Stephens RJ , et al. Chemotherapy for patients with non-small cell lung cancer: the surgical setting of the Big Lung Trial. Eur J Cardiothorac Surg 2004; 26 (1) 173-182
    CrossrefPubMedGoogle Scholar
  • 21 Cerfolio RJ, Bryant AS, Eloubeidi MA. Routine mediastinoscopy and esophageal ultrasound fine-needle aspiration in patients with non-small cell lung cancer who are clinically N2 negative: a prospective study. Chest 2006; 130 (6) 1791-1795
    CrossrefPubMedGoogle Scholar
  • 22 Sawhney MS, Bakman Y, Holmstrom AM, Nelson DB, Lederle FA, Kelly RF. Impact of preoperative endoscopic ultrasound on non-small cell lung cancer staging. Chest 2007; 132 (3) 916-921
    CrossrefPubMedGoogle Scholar