Chest
Volume 117, Issue 6, June 2000, Pages 1577-1582
Journal home page for Chest

Clinical Investigations
CANCER
Clinical Predictors of N2 Disease in Non-small Cell Lung Cancer

https://doi.org/10.1378/chest.117.6.1577Get rights and content

Objectives

To identify clinical or radiologic predictors of mediastinal lymph node involvement in patients with non-small cell lung cancer, and to define the indications of preoperative mediastinoscopy.

Methods

From August 1992 through April 1997, 387 patients with lung cancer (290 adenocarcinoma and 97 squamous cell carcinoma) underwent surgical resection. We retrospectively measured all mediastinal lymph node sizes both in the shortest and longest axes on contrast-enhanced CT scan to determine the optimal size criteria. Using multivariate logistic regression analysis, we identified clinical or radiologic predictors of N2 disease.

Results

We could not identify reliable size criteria for nodal involvement. We found two significant predictive factors of N2 disease on the basis of multivariable analysis: maximum tumor dimension and serum carcinoembryonic antigen (CEA) concentrations. The lymph node size did not prove to be a significant factor. Among 50 patients with serum CEA concentrations< 5.0 ng/mL and maximum tumor dimension < 20 mm, pathologic N2 disease was proven only in three patients (6%), regardless of the lymph node size on CT scan. Among 140 patients with serum CEA concentrations ≥ 5.0 ng/mL and maximum tumor dimension ≥ 20 mm, approximately one third (n = 46) showed N2 disease.

Conclusion

Serum CEA concentrations and maximum tumor dimension were more valuable in predicting N2 disease than the lymph node size on CT scan. Mediastinoscopy is indicated in patients with serum CEA concentrations ≥ 5.0 ng/mL and maximum tumor dimension ≥ 20 mm, and not indicated in patients with serum CEA concentrations< 5.0 ng/mL and maximum tumor dimension < 20 mm.

Section snippets

Materials and Methods

Between August 1992 and April 1997, 634 lung cancer patients underwent surgical intervention at our institute. Among them, 387 patients had adenocarcinoma or squamous cell carcinoma, and underwent major lung resection and systematic lymph node dissection. They were enrolled in this study. Five of them underwent preoperative mediastinoscopy, which revealed no mediastinal node involvement. The following patients were excluded: (1) patients who had received induction therapy, (2) patients with

Results

The clinical and radiologic characteristics of the patients are presented in Table 1 . There were 237 men and 150 women. The ages ranged from 33 to 84 years, with an average of 63 years. There were 79 among 387 overall patients (20%) with pN2 disease, 61 among 290 adenocarcinoma patients (21%) and 18 among 97 squamous cell carcinoma patients (19%), respectively. The average size of mediastinal lymph node was 6 mm in the shortest axis and 11 mm in the longest axis. Squamous cell carcinoma had

Discussion

Inasmuch as primary surgery for N2 NSCLC resulted in poor outcome, some authors concluded that surgery is contraindicated in N2 disease.22 However, several other studies suggested that induction chemotherapy or chemoradiation followed by surgical resection resulted in pathologic down-staging and better long-term survival in patients with N2 disease.23, 2425 Therefore, accurate preoperative staging of the mediastinum is important in deciding NSCLC treatment strategy.

Several reports advocated

ACKNOWLEDGMENT

The authors thank Dr. Satoshi Sasaki, Epidemiology and Biostatistics Division, National Cancer Center Research Institute East, for his technical support in performing the statistical analyses. We also thank Prof. J. Patrick Barron, International Medical Communications Center, Tokyo Medical University, for reviewing the English manuscript.

References (33)

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Supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare, Japan.

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