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

Department of General Thoracic Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama, Kure City, Hiroshima 737-0023, Japan.
Lung cancer (Amsterdam, Netherlands) (Impact Factor: 3.96). 01/2012; 76(1):93-7. DOI: 10.1016/j.lungcan.2011.07.015
Source: PubMed


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.

5 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES Understanding the clinicopathological features of patients with skip N2 metastases (SN2) in clinical early stage lung cancer is important for surgical planning and other treatment considerations; however, the factors associated with SN2 are unclear. This study aimed to investigate the clinicopathological features associated with SN2 in patients with clinical stage IA (cIA) non-small-cell lung cancer (NSCLC).
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2014; 47(4). DOI:10.1093/ejcts/ezu244 · 3.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: La chirurgie reste la meilleure chance de guérison à terme du cancer bronchique primitif. Elle ne peut être proposée qu’aux patients dont l’extension locale autorise une exérèse radicale. L’amélioration de certaines techniques d’assistance circulatoire, d’ostéosynthèse ou de remplacement prothétique permettent à l’heure actuelle d’envisager une exérèse radicale y compris en cas d’atteinte localement avancée. Nous revoyons ici ces différentes techniques pour chaque structure potentiellement envahie et commentons le risque opératoire et le bénéfice à terme. Le stade N2 anime une controverse. Si certains estiment que la chirurgie doit se limiter aux patients dont le stade N a été diminué sous chimiothérapie d’induction, il existe également des arguments en faveur de l’exérèse systématique chez les patients inopérables. L’attitude vis-à-vis de la pneumonectomie doit être nuancée ; elle peut être proposée à des patients rigoureusement sélectionnés, y compris après chimiothérapie d’induction.
    Revue des Maladies Respiratoires Actualites 09/2014; 6(4). DOI:10.1016/S1877-1203(14)70598-1