Prognostic factors in surgically resected N2 non-small cell lung cancer: the importance of patterns of mediastinal lymph nodes metastases.
ABSTRACT Patients with non-small cell lung cancer (NSCLC) with metastases to ipsilateral mediastinal lymph nodes (N2) are an heterogeneous group of patients as regard to prognosis and treatment. Indication and timing of surgery remain controversial. The present study investigates the prognostic factors, in order to identify homogenous subgroups of patients.
Histologically proven N2-NSCLC patients, who underwent a complete surgical resection were retrospectively reviewed. Clinical and pathological features were reported and analyzed, and survival study was performed.
One hundred eighty-three patients were analyzed. Overall 1.3 and 5 years survival rates were, respectively, 70, 35 and 20%, with a median survival time of 24 months. Univariate analysis showed a significant better prognosis for: incidental N2 respect to clinical N2 (5-years 35.4 vs 17.4%); single level lymph node involvement respect to multiple levels (5-years 23.8 vs 14.7%); metastases to superior mediastinal or aortic nodes respect to lower mediastinal nodes (5-years 32 and 24.3 vs 16.3%); right upper lobe tumors with superior mediastinal nodes and left upper lobe tumors with aortic nodes respect to lower lobes tumors with lower mediastinal nodes (5-years 31.8 and 26.9 vs 15.7%). Skip metastases had not a significant survival advantage respect to continuous lymphatic spread. N2 clinical status, the number of levels involved and the two specific patterns of lymphatic spread resulted significant prognostic factors at multivariate analysis.
Clinical N2 status, number of lymph nodes levels involved and specific patterns of lymphatic spread identify homogenous subgroups of patients that can be proposed for different therapeutic strategies.
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ABSTRACT: Introduction: The N2 /IIIA Non small cell Lung cancer is a heterogenous group of patients with many differ-ences within the stage that warrant different treatment strategies and have an individual prognosis that varies depending on the size, site and number of lymph node stations involved. Method: Review of the pertinent current literature on the identification of the various subsets of N2 disease and their man-agement and prognosis. Discussion: Define the spectrum of N2 disease and characterize the subsets within the stage. Highlight the different man-agement strategies and prognosis of the various N2 scenarios that are commonly seen. Examine the evidence for restaging after neoadjuvant therapy and the modalities that may be used. Summary: A concise outline of the subsets within the N2/IIIA stage with their evidence based treatment and survival.Current Cancer Therapy Reviews 01/2007; 300.