Prognostic factors in resected pathological N1-stage II nonsmall cell lung cancer
ABSTRACT Stage II non-small cell lung cancer (NSCLC) has been redefined in the 7th edn of Tumour-Node-Metastasis (TNM) classification for lung cancer. Stage IIa and Stage IIb both contain node-negative (N0) and node-positive (N1) subgroups. The aim of this study was to evaluate the prognostic factors for overall survival in patients with resected N1-stage II NSCLC.Between January 1992 and December 2010, we retrospectively reviewed the clinicopathological characteristics of 163 N1-stage II (T1a-T2bN1M0) NSCLC in patients undergoing curative resection as primary treatment.Median follow-up time was 37.2 months. The 1-, 3-, and 5-year overall survival rates were 85.3%, 62.1%, and 43.5%, respectively. Tumour involvement of hilar/interlobar nodal zone and poorly differentiated histological grade were significant predictors for worse overall survival using multivariate analysis (p=0.001 and p=0.015, respectively). There were trends toward worse overall survival in older patients and greater tumour size (p=0.063 and p=0.075, respectively).In resected N1-stage II NSCLC, hilar/interlobar nodal involvement and poorly-differentiated histologic grade were significant predictors of worse overall survival. The differences in survival between these subgroups of patients may lead to the use of different adjuvant therapies or postsurgical follow-up strategies.
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ABSTRACT: BACKGROUND: The non-small-cell lung cancer (NSCLC) staging system published in the 7th edition of the Union for International Cancer Control (UICC) and American Joint Commission on Cancer (AJCC) cancer staging manuals in 2009 did not include any changes to current N descriptors for NSCLC. However the prognostic significance of the extent of lymph node (LN) involvement, including the lymph node zones involved (hilar/interlobar or peripheral), cancer-involved lymph node ratios (LNR), and the number of involved lymph nodes remain unknown. The aim of this report is to evaluate the extent of lymph node involvement and other prognostic factors in predicting outcome after definitive surgery among Chinese stage II-N1 NSCLC patients. METHODS: We retrospectively reviewed the clinicopathological characteristics of 206 stage II (T1a-T2bN1M0) NSCLC patients who had undergone complete surgical resection at Shanghai Chest Hospital from June 1999 to June 2009. Overall survival (OS) and disease-free survival (DFS) were compared using Kaplan-Meier statistical analysis. Stratified and Cox regression analyses were used to evaluate the relationship between the lymph node involvement and survival. RESULTS: Peripheral zone lymph node involvement, cancer-involved lymph node ratio, smaller tumor size, and squamous cell carcinoma were shown to be statistically significant indicators of higher OS and DFS by univariate analyses. Visceral pleural involvement was also shown to share a statistically significant relationship with DFS by univariate analyses. Multivariate analyses showed tumor size and zone of lymph node involvement were to be significant predictors of OS. CONCLUSION: Zone of N1 lymph node, LNR and tumor size were both found to provide independent prognostic information in patients with stage II NSCLC. This information may be used to stratify patients into groups by risk for recurrence.Chest 06/2013; 144(4). DOI:10.1378/chest.13-0073 · 7.13 Impact Factor
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ABSTRACT: Lung cancer is the leading cause of cancer death in Taiwan. This study investigated the prognostic factors affecting survival of patients with lung cancer in Taiwan. Data were obtained from the National Health Insurance Research Database published in Taiwan. Clinicopathologic profiles and prognostic factors of 33,919 lung cancer patients were analyzed between 2002 and 2008 in this retrospective review. The impact of the clinicopathologic factors on overall survival was assessed. Nearly two thirds of the patients were men. The 5-year survival rate was 15.9%, with a median survival of 13.2 months. The clinical staging of the patients included stage I (n = 4254; 12.5%), stage II (n = 1140; 3.4%), stage III (n = 10,161; 30.0%), and stage IV (n = 18,364; 54.1%). In the multivariate analysis, age more than 65 years, sex, cell type, histologic grade, and primary tumor location were identified as independent prognostic factors. In additional to tumor-nodes-metastasis (TNM) staging system, patient sex and age, tumor location, cell type, and differentiation were independent prognostic factors. We recommend incorporation of these factors to subclassify lung cancer patients.Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 09/2013; 8(9):1128-35. DOI:10.1097/JTO.0b013e31829ceba4 · 5.80 Impact Factor