Role of skip metastasis to mediastinal lymph nodes in non-small cell lung cancer

BACKGROUND: Skip metastasis to mediastinal lymph nodes is a well-known phenomenon in non-small cell lung cancer (NSCLC). Little is reported in the literature about its clinical importance. It is still under discussion whether any prognostic differences exist between resected NSCLC with either skip metastases or continuous mediastinal lymph node metastases (N2). PATIENTS AND METHODS: We analyzed retrospectively the data of 45 patients with a pN2-stage, who underwent resection for NSCLC. Seventeen of these patients (37.8%), showing no metastatic involvement of hilar (N1) lymph nodes, were compared to the remaining 28 patients with infiltration of hilar nodes (N1) as well as N2 nodes. RESULTS: Multivariate analysis showed no statistically significant difference between the skip metastasis and the continuous N2 group regarding sex, age, histology, T- or M-status. The frequency of skip metastasis was higher in patients with a primary tumor in the upper lobe (n = 12, 71%) compared to the lower lobe (n = 5, 29%). This difference was not statistically significant. In patients with a non-continuous lymph node spread, 29 out of 119 resected mediastinal lymph nodes were infiltrated (1.7 per patient, range: 1-10). Compared to 83 metastatic involved lymph nodes out of 198 resected mediastinal nodes (three per patient, range: 1-10) in patients with involvement of N1 and N2 nodes (P = 0.034, Mann-Whitney test). The 5-year survival rate of pN2 patients with skip metastasis was 41% compared to 14% in patients with involvement of N1 and N2 nodes (P = 0.019). CONCLUSIONS: pN2 patients with mediastinal lymph node skip metastasis have a more favorable prognosis compared to pN2 patients with continuous infiltration of the regional lymph nodes. Patients with a continuous lymph node involvement show an increased number of infiltrated mediastinal lymph nodes per patient compared to patients with a non-continuous spread. Skip metastasis is an independent prognostic factor of survival. The presence of skip metastasis seems to be a unique subgroup of pN2 disease in NSCLC.     

The surgical prognosis of pIIIA/N2 non-small-cell lung cancers

Objective

The aim of the study was to identify prognostic factors in non-small-cell lung cancer (NSCLC) with N2 nodal involvement.

Methods

A retrospective analysis of disease free survival and 5-year survival for NSCLC patients who underwent primary surgical resection without neoadjuvant chemotherapy were performed. Between January 1998 and May 2004, 133 patients were enrolled. Several factors such as age, sex, skip metastasis, number of N2 lymph node stations, type of resection, histology, adjuvant therapy etc., were recorded and analyzed. SPSS 16.0 software was used.

Results

Overall 5-year survival for 133 patients was 32.33%, 5-year survival for single N2 station and multiple N2 stations sub-groups were 39.62% and 27.50% respectively, and 5-year survival for cN0?C1 and cN2 sub-groups were 37.78% and 20.93% respectively. COX regression analysis revealed that number of N2 station (P = 0.013, OR: 0.490, 95% CI: 0.427?C0.781) and cN status (P = 0.009, OR: 0.607, 95% CI: 0.372?C0.992) were two favorable prognostic factors of survival.

Conclusion

Number of N2 station and cN status were two favorable prognostic factors of survival. In restrict enrolled circumstances, after combined therapy made up of surgery and postoperative adjuvant therapy have been performed, satisfied survival could be achieved.     

通过生存分析评价纵隔镜检查在非小细胞肺癌术前纵隔淋巴结分期中的作用

目的 通过生存分析评价纵隔镜检查在评估非小细胞肺癌(NSCLC)术前纵隔淋巴结状态中的作用.方法 对152例可手术NSCLC患者术前行CT和纵隔镜检查,根据纵隔镜检查结果选择不同的方案进行治疗,并进行长期随访.纵隔淋巴结分期按最终病理结果分为pN0、pN1、pN2和pN3,按CT检查分为cN0～1和cN2～3,按纵隔镜检查分为mN0～1、mN2和mN3.结果 pN0组、pN1组、pN2组和pN3组的5年生存率分别为61.7%、75.0%、32.4%和16.1%,pN0组、pN1组的生存率与pN2组、pN3组相比均显著升高(均P<0.05).cN0～1组与cN2～3组之间的生存率差异无统计学意义(P=0.670).mN0～1组与mN2组、mN3组的生存率差异均有统计学意义(均P<0.05).结论 开胸手术前行纵隔镜检查能较好地判断NSCLC患者的纵隔淋巴结转移情况,预测患者的预后.     

Patterns of relapse of N2 nonsmall-cell lung carcinoma patients treated with preoperative chemotherapy: should prophylactic cranial irradiation be reconsidered?

BACKGROUND: Although it induces a relevant reduction in the risk of both visceral metastases and locoregional recurrences, the combination of chemotherapy and surgery only marginally improves the survival of patients with Stage IIIA(N2) (International Union Against Cancer staging and classification system) nonsmall-cell lung carcinoma (NSCLC). The purpose of the current study was to analyze the patterns of relapse in these patients. METHODS: In this study, the authors compared the patterns of relapse in 81 patients with clinically detectable N2 NSCLC who had been treated with preoperative chemotherapy with the relapse patterns of 186 comparable patients who had been treated with primary surgery. Clinically detectable N2 (cN2) denotes mediastinal lymph node enlargement on computed tomography scan, which then is confirmed by mediastinoscopy. RESULTS: Overall 20% of patients developed a locoregional recurrence. Chemotherapy decreased the risk of visceral metastasis as 28% of the patients preoperatively treated and 38%of those not treated with preoperative chemotherapy presented a visceral metastasis (P < 0.05). Preoperative chemotherapy and adenocarcinoma subtypes were associated with a higher rate of brain metastasis (P < 0.05). Thirty-two percent of the patients treated preoperatively and 18% of those not treated with preoperative chemotherapy presented a brain metastasis (P < 0.05), which was isolated in 22% and 11% of the patients, respectively (P < 0.05). CONCLUSION: The current study found that preoperative chemotherapy for cN2 decreases the risk of visceral metastasis but is associated with a high rate of isolated brain metastases. Prophylactic cranial irradiation may need to be reinvestigated in clinical trials, especially in patients who present with an adenocarcinoma.     

Prognostic implications of cell cycle-related proteins in primary resectable pathologic N2 nonsmall cell lung cancer

BACKGROUND: Patients who have pathologic N2 (pN2) nonsmall cell lung cancer (pN2 NSCLC) represent a heterogeneous group with regard to prognosis and treatment. Molecular features of NSCLC seem to be of interest. For the current study, to select an appropriate therapeutic strategy for each patient, patients with N2 NSCLC were stratified into homogenous subgroups according to the expression profiles of cell cycle-related markers. METHODS: The expression levels of retinoblastoma protein (pRb), cyclin D1, p16, p53, and p21 proteins and values of the Ki-67 labeling index were evaluated in 61 primary surgically resected tumor specimens from patients with pN2 NSCLC using immunohistochemistry. The prognostic impact of these markers on overall survival was analyzed in both univariate and multivariate analyses. RESULTS: In univariate analysis, p21, p16, and Ki-67 were correlated significantly with survival. In multivariate analysis, only p21 and p16 influenced survival. Indeed, the group of patients with pN2 NSCLC who were positive for p21 and p16 had the most favorable overall survival (P = .001) and were correlated significantly with the clinical lymph node (cN) status (cN2 disease; P = .008). Moreover, no significant difference in survival was observed between patients with cN0/cN1 disease and patients with cN2 disease within the group (P = .4333). CONCLUSIONS: Loss of control of cell-cycle checkpoints is a common occurrence in pN2 NSCLC. Functional cooperation between different cell-cycle regulators constitutes another level of regulation in cell growth control and tumor suppression. Preoperative patients with pN2 NSCLC, even those with cN2 disease, who have positive p21 and p16 protein expression in their primary tumors are expected to have a favorable postoperative prognosis and may be candidates for primary resection.     

Size of breast cancer metastases in axillary lymph nodes: clinical relevance of minimal lymph node involvement.

BACKGROUND: Overt ipsilateral axillary lymph node metastases of breast cancer are the most significant prognostic indicators for women who have undergone surgery, yet the clinical relevance of minimal involvement (isolated tumor cells and micrometastases) of these nodes is uncertain. PATIENTS AND METHODS: We evaluated biologic features, adjuvant treatment recommendations, and prognosis for 1,959 consecutive patients with pT1-3, pN0, minimal lymph node involvement (pN1mi or pN0i+), or pN1a (single positive node) and M0, who were operated on and counseled for medical therapy from April 1997 to December 2000. RESULTS: Patients with pN1a and pN1mi/pN0i+, when compared with patients with pN0 disease, were more often prescribed anthracycline-containing chemotherapy (39.1% v 33.2% v 6.1%, respectively; P < .0001) and were less likely to receive endocrine therapy alone (9.8% v 19.4% v 41.9%, respectively; P < .0001). At the multivariate analysis, a statistically significant difference in disease-free survival (DFS) and in the risk of distant metastases was observed for patients with pN1a versus pN0 disease (hazard ratio [HR] = 2.04; 95% CI, 1.46 to 2.86; P < .0001 for DFS; HR = 2.32; 95% CI, 1.42 to 3.80; P = .0007 for distant metastases) and for patients with pN1mi/pN0i+ versus pN0 disease (HR = 1.58; 95% CI, 1.01 to 2.47; P = .047 for DFS; HR = 1.94; 95% CI, 1.04 to 3.64; P = .037 for distant metastases). CONCLUSION: Even minimal involvement of a single axillary node in breast cancer significantly correlates with worse prognosis compared with no axillary node involvement. Further studies are required before widespread modification of clinical practice.     

Involvement of three or more lymph nodes predicts poor prognosis in submucosal gastric carcinoma

BACKGROUND: Multivariate analyses has shown that the status of lymph node metastasis and the depth of tumor penetration through the gastric wall are the most important prognostic factors in patients with advanced gastric carcinoma after curative operation. A clinicopathological study was carried out to clarify a simple and optimal prognostic indicator for early gastric cancer. METHODS: Retrospective analyses of 982 patients with early gastric cancer (562 with mucosal [M] and 420 with submucosal [SM] tumor) treated by gastrectomy with D2 lymph node dissection were performed. RESULTS: The incidence of lymph node metastasis from M and SM tumors was 2.5% (14/562) and 20.2% (85/420), respectively. There were no apparent prognostic indicators in patients with M tumors. In patients with SM tumors, the cancer-specific 5-year survival of those with lymph node metastasis was significantly lower than that of those without such metastasis (77.6% vs 98.2%; P < 0.001). An sharp decrease in survival was seen between patients with two positive nodes and those with three positive nodes, and the cancer-specific 5-year survival rate of patients with three or more metastatic lymph nodes was significantly lower than that of those with one or two nodes (P < 0.001; univariate analysis). Multivariate analysis revealed that the involvement of three or more lymph nodes was the sole independent prognostic determinant (P = 0.016); the level of nodal metastasis was not an independent prognostic factor (P = 0.384). All patients with N2 lymph node echelons (according to the Japanese Research Society for Gastric Cancer classification of the draining lymph nodes of the stomach) in the group with one or two positive nodes survived for more than 5 years. CONCLUSION: The sole independent prognostic factor in SM gastric cancer is the involvement of three or more metastatic lymph nodes. We suggest that this simple prognostic indicator for the follow-up of early gastric cancer, and this could lead to potentially effective adjuvant chemotherapy.     

118例小肿块多腋窝淋巴结转移乳腺癌患者的临床特征和预后分析

目的分析小肿块多腋窝淋巴结转移(肿块直径≤2 cm、腋窝淋巴结转移≥4个)乳腺癌患者的临床特征和预后。方法1993年1月至2003年12月我院共收治小肿块多腋窝淋巴结转移乳腺癌患者118例,对其临床病理特征、辅助治疗进行分析,以发现相关的预后因素。结果全组患者的5年总生存率为75.0%。腋窝淋巴结转移4～9个及≥10个者的5年生存率分别为89.5%和59.8%(P=0.009),术后化疗患者与未化疗患者的5年生存率分别为82.1%和53.3%(P=0.001),术后内分泌治疗者与未行内分泌治疗者的5年生存率分别为89.2%和61.9%(P=0.001)。单因素Kaplan-Merier生存分析显示,肿瘤分期、术后化疗和内分泌治疗是影响患者预后的重要因素。Cox多因素预后分析显示,肿瘤分期、术后化疗和内分泌治疗是影响患者预后的独立因素。结论小肿块多腋窝淋巴结转移的乳腺癌患者具有易于转移的趋势,患者预后较差,尤其是腋窝淋巴结转移≥10个的患者;肿瘤分期、辅助化疗和内分泌治疗是影响患者预后的独立因素;合理的综合治疗有可能改善小肿块多腋窝淋巴结转移乳腺癌患者的预后。     

Ⅲ期N2非小细胞肺癌的外科治疗

目的：探讨Ⅲ期N2非小细胞肺癌（NSCLC）患者外科治疗的疗效及影响预后的因素。方法：回顾性分析1982－1996年手术治疗的266例Ⅲ期N2 NSCLC患者的5年生存率,与同期手术的N0、N1患者做比较,用Cox模型分析病理分型、淋巴结转移数目、淋巴结转移区域、手术方式、T状态、手术性质等对N2的NSCLC患者预后的影响。结果：266例Ⅲ期N2的NSCLC患者的5年生存率为17．3％,明显低于同期N0、N1患者的5年生存率（51．4％和30．4％）,淋巴结转移数目、淋巴结转移区域、T状态、手术性质为影响预后的重要因素。结论：对单区域纵隔淋巴结转移且估计能完全切除的Ⅲ期N2（特别是T1）NSCLC应采取以手术为主的综合治疗。     

Disseminated tumor cells in lymph nodes as a determinant for survival in surgically resected non-small-cell lung cancer.

PURPOSE: In recent years, the detection of even a few tumor cells in lymph nodes of patients with surgically resected non-small-cell lung cancer (NSCLC) became possible with immunohistochemical staining procedures. Tumor cells in lymph nodes have been shown to be associated with an increased rate of early recurrence. However, the prognostic significance of this minimal tumor cell spread for overall survival remains unclear. PATIENTS AND METHODS: We used the epithelium-specific monoclonal antibody Ber-EP4, which recognizes the 17-1A antigen (also called EGP40 or Ep-CAM), to discover small tumor cell deposits (< or = three cells) in 565 regional lymph nodes judged as tumor-free by conventional histopathology in patients with NSCLC staged as pT1-4, pN0-2, M0, R0. In a prospective analysis, we studied the influence of the detected tumor cells on the cancer recurrence rate and survival of 117 patients. RESULTS: Ber-EP4-positive cells were found in 27 of 125 patients (21.6%). After an observation period of 64 months, patients with disseminated tumor cells had reduced disease-free survival (P < .0001) and overall survival (P = .0001) rates in univariate analyses (logrank test). Multivariate analysis (Cox model) showed a 2.7 times increased risk for tumor relapse and a 2.5 times increased risk for shorter survival in patients with disseminated tumor cells compared with patients without such cells. Patients without any evidence of histopathologic and immunohistochemical lymph node involvement had an overall survival rate of 78%. CONCLUSION: The immunohistochemical detection of disseminated tumor cells in lymph nodes of patients with completely resected NSCLC is an independent prognostic factor for overall survival.     

181例肺腺鳞癌患者术后预后因素分析

  目的  探讨术后Ⅰ~Ⅲ期肺腺鳞癌患者的预后及其影响因素。  方法  按照2009年国际肺癌研究协会公布的新版肺癌分期标准进行分期, 回顾性分析1994年1月至2008年12月天津医科大学附属肿瘤医院收治181例手术切除的Ⅰ~Ⅲ期肺腺鳞癌患者的临床资料, 对影响其预后的各因素进行了单因素及多因素分析。  结果  全组患者3、5年生存率分别为30.9%、19.0%, 中位生存期23.0个月。单因素分析显示淋巴结清扫方式、T分期、N分期、辅助化疗周期数是影响预后的重要因素(P < 0.05)。多因素分析结果显示淋巴结清扫方式(P=0.046)、T分期(P=0.006)、N分期(P < 0.001)、辅助化疗周期数(P=0.031)是影响预后的独立因素。  结论  肺腺鳞癌整体预后差。系统性淋巴结清扫能显著提高肺腺鳞癌患者生存时间。肿瘤的T分期越高其生存率越低, 无区域淋巴结转移组生存率较高。Ⅲ期肺腺鳞癌患者可从术后辅助化疗中获益, 应至少行4个化疗周期。      

Prognostic impact of the primary tumor location based on the hilar structures in non-small cell lung cancer with mediastinal lymph node metastasis

The status of mediastinal lymph node metastasis is one of the main factors determining the treatment strategy for non-small cell lung cancer (NSCLC), but the primary tumor location is not considered crucial in the tumor-node-metastasis (TMN) classification at present. The aim of this study was to estimate the prognostic value of the primary tumor location on the basis of the hilar structures in NSCLC with mediastinal lymph node metastasis. We retrospectively reviewed the cases of 337 consecutive patients who underwent surgical resection for NSCLC between 1995 and 2004, divided the pN2 NSCLC cases (n=40) into central- and peripheral-type tumors according to the distance of the primary tumor from the first branch of the extrapulmonary bronchus, and compared the surgical outcomes between these tumor groups. Eighteen and twenty-two cases were classified as central- and peripheral-type tumors, respectively. The 5-year survival rate was significantly better for patients with central-type tumors than peripheral-type tumors (51.5% vs. 21.2%, P=0.034). The location-specific prognostic tendency was noted irrespective of the presence (n=13) or absence of skip metastasis. In a multivariate Cox analysis of the N2 NSCLC cases, the primary tumor location was a significant (P=0.026) prognostic factor for overall survival. In conclusion, evaluation of the primary tumor location based on the hilar structures is useful to predict the prognosis in N2 NSCLC.     

N1期非小细胞肺癌预后分析

目的 探讨非小细胞肺癌患者中N1的临床意义及与NO和N2的异同。方法 以1982年1月－1994年12月我院138例行根治性手术N1期NSCLC患者为研究对象,根据肺癌淋巴结分布图将N1分为叶内N1与叶外N2两亚组,与同期NO期307例、N2期176例行根治性手术NSCLC患者作比较,分析术后五年生存率。结果 138例N1期NSCLC患者五年生存率为30．4％,叶内N1与叶外N2两亚组五年生存率有显著性差别（50．3％比26．5％,P＝0．001）,且叶内N1亚组与NO组五年生存率相似（51．4％比50．3％）,而叶外N1亚组与单一区域N2期五年生存率相似（26．5％比23．5％）。结论 N1分为二亚组,叶内1亚组与NO期特性相似,叶外N1亚组与单一区域N2期特性相似。     

腺癌与其他类型非小细胞肺癌术后临床特点的差异及预后因素分析

背景与目的:近年来肺腺癌已成为肺癌最常见的病理类型,且呈逐年上升的趋势.该研究探讨肺腺癌与其他类型非小细胞肺癌(non-small cell lung cancer,NSCLC)术后临床特点的差异及影响其术后预后的因素.方法:选取广西医科大学附属肿瘤医院2005年1月1日—2014年12月31日经手术治疗的NSCLC患者的病历资料,比较腺癌与其他类型癌临床特点的差异,并运用log-rank方法及Cox比例风险回归模型分析影响腺癌术后预后的因素.结果:451例腺癌患者中,男性与女性比例为1.29:1,平均发病年龄为56.02岁,淋巴结转移率为53.22%(240/451),中位生存期为44个月;其与其他类型NSCLC在性别比例(P<0.001)、平均发病年龄(P=0.039)、淋巴结转移率(P=0.012)和中位生存期(P<0.001)方面差异均有统计学意义.多因素分析显示:PTNM分期(P<0.001)、性别(P=0.032)、术前合并糖尿病(P=0.019)、隆突下淋巴结转移(P=0.013)、淋巴结转移组数(P<0.001)、术后化疗(P=0.040)或靶向治疗(P<0.001)是影响腺癌术后预后的独立因素.结论:与其他类型NSCLC相比,腺癌具有女性发病率高、平均发病年龄较低、淋巴结转移率较高和预后较差的特点;PTNM分期、性别、术前合并糖尿病、隆突下淋巴结转移、淋巴结转移组数、术后化疗或靶向治疗是影响其术后预后的重要因素,可为评估预后提供参考.     

1380例手术后的非小细胞肺癌的多因素预后分析

背景与目的 非小细胞肺癌的预后影响因素较多。本研究旨在结合临床资料对非小细胞肺癌术后的预后及其影响因素进行分析。方法 回顾性分析自1996年1月至2003年1月1380例手术治疗的非小细胞肺癌患者的资料，对影响其预后的临床病理因素进行了单因素及多因素分析。结果 全组1、3、5年生存率分别为78．85％、49．78％和38．96％，中位生存时间38．77月。单因素分析显示患者肿瘤大小、病理类型、临床类型（中心型和周围型）、病理分期、淋巴结转移情况、手术方式、术后是否化疗及化疗周期数是影响预后的因素，多因素分析显示肿瘤大小、病理分期、淋巴结转移情况及术后是否化疗和化疗的周期数是影响预后的独立因素。结论 对于手术治疗的非小细胞肺癌患者，肿瘤大小、病理分期、淋巴结转移情况及术后化疗情况是独立的预后因素。     

Ⅳ期声门型喉癌的治疗与预后分析

背景与目的:Ⅳ期声门型喉癌预后较差。本研究探讨Ⅳ期声门型喉癌的治疗方式以及颈淋巴结转移、手术切缘情况对预后的影响。方法:收集88例Ⅳ期声门型喉癌的临床资料,回顾性分析不同治疗方式、有否颈淋巴结转移及手术切缘阴性和阳性患者的生存情况。结果:Ⅳ期声门型喉癌总的3、5年生存率分别为71.6%、63.0%;采用单纯手术、手术加术后放疗、化疗加放疗及手术加化疗治疗的患者,其生存率差异均无统计学意义(P=0.729);初治时有淋巴结转移的患者比初治时无淋巴结转移的患者预后差(P=0.015);无淋巴结转移的患者中有隐性淋巴结转移者与无隐性淋巴结转移者生存率差异均无统计学意义(P=0.474);手术切缘阳性者术后放疗与阴性者相比,其生存率差异均有统计学意义(P=0.016)。结论:N分期是影响Ⅳ期声门型喉癌患者预后的重要因素,初治有淋巴结转移者预后差。手术切缘阳性者术后放疗生存率低于手术切缘阴性者。     

肺癌纵隔淋巴结合理廓清范围的临床探讨

目的：探讨非小细胞肺癌(NSCLC)纵隔淋巴结转移方式。方法：回顾性研究1989年1月—1999年1月，淋巴结廓清术后病理证实的纵隔淋巴结转移(pN2)137例。分析临床病理因素与pN2的关系．应用Logistic回归分析判定纵隔淋巴结CT扫描阴性时(cN0-1)pN2有意义的预测指标；总结不同位置肺癌纵隔淋巴结转移的方式。结果：NSCLC无论病理类型和临床状态如何，均有纵隔淋巴结转移发生。纵隔淋巴结增大(cN2)和cT2或cT3腺癌患者转移的发生率较高(65．0％，75．0％)。纵隔淋巴结转移多为区域性(80．9％)，跨区域纵隔淋巴结转移多数伴有隆凸下淋巴结受累。结论：对NSCLC应行纵隔淋巴结廓清，尤其对cN2和cT3、cT3腺癌。多数患者单独廓清区域纵隔淋巴结即可达到目的。建议手术中对肺门和隆凸下淋巴结冰冻病理检查，无转移时可不必廓清非区域纵隔淋巴结。     

Survival and characteristics of lymph node involvement in patients with N1 non-small cell lung cancer

N1 non-small cell lung cancer (NSCLC) encompasses a heterogeneous subgroup with differential lymph node involvement. Among 738 patients with NSCLC who underwent surgical resection, including 579 patients (78.5%) with systematic hilar and mediastinal lymph nodal dissection, from 1992 to 2001, 82 patients were pathologically defined as having N1 disease. We retrospectively analyzed the factors influencing survival, including the characteristics of lymph node involvement; the location of involved stations, the number of involved stations, the number of involved nodes, and the status of nodal involvement (microscopic N1, nodal involvement first defined by postoperative histological examination; or macroscopic N1, nodal involvement obviously recognized by preoperative examinations or surgical explorations). The overall 5-year survival rate of the 82 patients with N1 disease was 50.9%. No significant differences in the overall survival were found with regard to gender, age, histologic type, type of resection, or adjuvant therapies. Pathologic T status significantly influenced the overall survival (T1 versus T2 disease, P=0.008). According to the characteristics of lymph node involvement, the prognosis of patients with multiple-node N1 involvement was significantly poorer than that of those with single-node N1 involvement (5-year survival: 29.6% versus 61.5%, p=0.003). The prognosis of patients with macroscopic N1 disease was significantly poorer than that of those with microscopic N1 disease (5-year survival: 43.0% versus 65.0%, P=0.046). By comparison with the survival of patients who underwent surgical resection during the same period for pathologic N0 (pN0) and pathologic N2 (pN2) diseases, no survival differences were observed between microscopic N1/single-node N1 and pN0, or between multiple-node N1 and pN2 diseases. In patients with pathologic N1 disease, microscopic N1 and single-node N1 diseases may be an early stage, whereas multiple-node N1 disease behaves like an advanced stage.     

Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial.

PURPOSE: A multicenter, phase II trial investigated the efficacy and toxicity of neoadjuvant docetaxel-cisplatin in locally advanced non-small-cell lung cancer (NSCLC) and examined prognostic factors for patients not benefiting from surgery. PATIENTS AND METHODS: Ninety patients with previously untreated, potentially operable stage IIIA (mediastinoscopically pN2) NSCLC received three cycles of docetaxel 85 mg/m2 day 1 plus cisplatin 40 mg/m2 days 1 and 2, with subsequent surgical resection. RESULTS: Administered dose-intensities were docetaxel 85 mg/m2/3 weeks (range, 53 to 96) and cisplatin 95 mg/m2/3 weeks (range, 0 to 104). The 265 cycles were well tolerated, and the overall response rate was 66% (95% confidence interval [CI], 55% to 75%). Seventy-five patients underwent tumor resection with positive resection margin and involvement of the uppermost mediastinal lymph node in 16% and 35% of patients, respectively (perioperative mortality, 3%; morbidity, 17%). Pathologic complete response occurred in 19% of patients with tumor resection. In patients with tumor resection, downstaging to N0-1 at surgery was prognostic and significantly prolonged event-free survival (EFS) and overall survival (OS; P =.0001). At median follow-up of 32 months, the median EFS and OS were 14.8 months (range, 2.4 to 53.4) and 33 months (range, 2.4 to 53.4), respectively. Local relapse occurred in 27% of patients with tumor resection, with distant metastases in 37%. Multivariate analyses identified mediastinal clearance (hazard ratio, 0.22; P =.0003) and complete resection (hazard ratio, 0.26; P =.0006) as strongly prognostic for increased survival. CONCLUSION: Neoadjuvant docetaxel-cisplatin is effective and tolerable in stage IIIA pN2 NSCLC. Resection is recommended only for patients with mediastinal downstaging after chemotherapy.     

Prognostic implication of metastasis limited to segmental (level 13) and/or subsegmental (level 14) lymph nodes in patients with surgically resected nonsmall cell lung carcinoma and pathologic N1 lymph node status

BACKGROUND:

In patients with nonsmall cell lung carcinoma (NSCLC) who have with pathologic N1 (pN1) lymph node status, the prognostic significance of segmental lymph node (level 13) metastasis and/or subsegmental lymph node (level 14) metastasis is unknown.

METHODS:

Lymph node metastasis patterns were analyzed in 230 patients with NSCLC who had pN1 status. Clinical outcomes were examined for 230 patients with pN1 status and 700 patients with pN0 status. The pN1 group was stratified into 4 subgroups according to the highest level of lymph node involvement.

RESULTS:

The 5‐year disease‐free survival (5DFS) rates for pN1 and pN0 patients were 50.1% and 90.5%, respectively. The highest level of lymph node involvement was a significant prognostic indicator; the 5DFS rates for patients with pN1 status who had level 13/14, lobar (level 12), interlobar (level 11), and hilar (level 10) lymph node metastasis were 69.4%, 46.4%, 46.7%, and 37%, respectively. Patient outcomes were significantly worse for those with pN1 status who had only level 13/14 lymph node metastasis than for patients with pN0 status (P = .0034), and outcomes were significantly worse for patients with pN1 status who had level 11/12 lymph node metastasis than for patients who had only level 13/14 lymph node metastasis (P = .021). The median number of level 13/14 lymph nodes examined was 3 (range, 0‐22 level 13/14 lymph nodes), and metastases to these lymph nodes were detected in 61% of patients who had pN1 status. A single lymph node pN1 disease, single‐level pN1 status, and squamous cell carcinoma histopathology also were indicators of a better patient outcome.

CONCLUSIONS:

The current results indicated that the highest level of lymph node involvement may be used to stratify the outcome of patients who have NSCLC with pN1 status. Patients with pN1 status who had only level 13/14 lymph node metastasis had an intermediate 5DFS rate between that of patients with pN0 status and other patients with pN1 status. Routine examination of level 13/14 lymph nodes is important for accurate pathologic staging and for the predicting clinical outcome of patients with NSCLC. Cancer 2012. © 2012 American Cancer Society.