Survival and prognostic factors in resected N2 non-small cell lung cancer: A study of 140 cases

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Background.

The selection of stage IIIA N2 non-small cell lung cancer patients for primary surgical treatment remains controversial.

Methods.

One hundred forty patients with resected non-small cell lung cancer who eventually proved to have pathologic N2 disease were studied with a univariate and multivariate analysis of prognostic factors.

Results.

Nineteen patients had a positive mediastinoscopy; the others had a preoperative N0 or N1 stage. Complete resection rate was 80.7%. Five-year survival was 20.8% (95% confidence interval, 17.2% to 24.4%), 32.2% in mediastinoscopy-negative patients. In the univariate analysis, clinical N stage at mediastinoscopy, complete resection, performance status, T stage, number of metastatic levels in adenocarcinoma, and nodal capsule rupture were important factors. In a multivariate model, survival was worse in case of higher T stage (relative risk = 1.43), lower performance status (relative risk = 1.37), involvement of more than one node level (relative risk = 1.68), nonsquamous histology (relative risk = 1.29) and clinical N2 stage (relative risk = 1.43). Long-term survival was unlikely when lactic dehydrogenase or carcinoembryonic antigen levels were elevated.

Conclusions.

In clinical NO or N1 cancer, complete resection resulted in reasonable survival prospects. In patients with N2 disease discovered at mediastinoscopy, surgical treatment was only worthwhile in case of minimal N2. Several unfavorable prognostic factors could be identified in the univariate analysis and confirmed in a multivariate Cox model.

References (29)

  • KirshM et al.

    Mediastinal metastases in bronchogenic carcinoma: influence of postoperative irradiation, cell type, and location

    Ann Thorac Surg

    (1982)
  • ThomasP et al.

    Should subcarinal lymph nodes be routinely examined in patients with non-small cell lung cancer?

    J Thorac Cardiovasc Surg

    (1988)
  • IcardP et al.

    Preoperative carcinoembryonic antigen level as a prognostic indicator in resected primary lung cancer

    Ann Thorac Surg

    (1994)
  • GoldstrawP

    The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer

    Thorax

    (1992)
  • Cited by (0)

    This study was supported in part by a private grant (8 E01 2010 27 1612) from Baron Georges Stalpaert, Emeritus Professor of Thoracic Surgery.

    *

    The members of the Leuven Lung Cancer Group are listed in Appendix 1.

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