[Two patterns of mediastinal lymph node resection for non-small cell lung cancer of stage IIIA: survival analysis of 219 cases].

Department of Thoracic Surgery, Tumor Hospital, Xinjiang Medical University, Ulumnqi, Xinjiang, 830011, PR China.
Ai zheng = Aizheng = Chinese journal of cancer (Impact Factor: 2.16). 05/2007; 26(5):519-23.
Source: PubMed


Correctly dealing with mediastinum lymph nodes during operation is critical to the prognosis of resectable non-small cell lung cancer (NSCLC) of stage IIIA, but the removal extent of mediastinum lymph nodes is controversial. This study was to explore the effects of 2 patterns of mediastinum lymph node resection on long-term survival of stage IIIA NSCLC patients.
Clinical data of 219 stage IIIA NSCLC patients, underwent complete resection from Jan. 1999 to Jan. 2004 in Xinjiang Tumor Hospital, were reviewed. Of the 219 patients, 109 underwent mediastinal lymph node sampling (LS), and 110 underwent systematic mediastinal lymphadenectomy (SML). Survival statuses of the patients were analyzed by Life table method and Kaplan-Meier method; the prognosis was analyzed with Cox multivariate regression model.
The 1-, 3-, and 5-year survival rates were 82%, 28%, 13% in LS group, and 88%, 37%, 16% in SML group. The median survival time was significantly longer in SML group than in LS group (23.5 months vs. 20.0 months, P<0.05). Cox multivariate analysis showed that histopathologic type, metastasis state of mediastinal lymph nodes, mediastinum lymph node resection pattern were prognostic factors of stage IIIA NSCLC patients.
As compared with LS, SML in radical operation could improve the survival rate of stage IIIA NSCLC patients.

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  • No preview · Article · Aug 2008 · Zhongguo fei ai za zhi = Chinese journal of lung cancer
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    ABSTRACT: Background and Objective: Clinical characteristics of skip N2 metastasis of stage III A non-small cell lung cancer (NSCLC) are not clear. This study was to investigate the clinicopathologic features and the distribution pattern of N2 lymph nodes, thus to analyze the relationship between the survival rate and skip metastasis of NSCLC patients. Methods: Clinical data of 292 patients with stage III A NSCLC undergoing radical surgical resection plus mediastinal nodal dissection in the Affiliated Hospital of Nantong University were retrospectively reviewed. Clinicopathologic features, distribution of skip N2 metastasis and survival were analyzed respectively. Results: The incidence rate of skip N2 metastasis in stage III A NSCLC patients was 15.8%, which was correlated to the size of the tumor (P<0.05). Moreover, the relationship between the primary tumor location and N2 positive lymph nodes were described as follows: right upper lobe cancer displayed skip-N2 nodal metastasis mostly in the 3rd and 4th station (85.7%), right middle lobe mostly in the 7th station (75.0%), right lower lobe mostly in the 3rd and 7th station (81.0%), left upper lobe mostly in the 5th and 6th station (80.0%), and left lower lobe mostly in the 7th station (65.0%). The 3-year survival rate of patients with skip N2 metastasis was 45.4%, compared to 29.5% in patients with the involvement of N1 and N2 nodes. Survival analysis showed that skip N2 metastasis was an independent risk factor of stage III A NSCLC in addition to tumor size, histology, type of resection, adjuvant chemotherapy and radiotherapy. Conclusions: In stage III A NSCLC, primary tumors in different locations have their own corresponding areas of N2 nodal metastasis. Skip N2 metastasis is an independent prognostic factor for the survival of NSCLC. Patients with skip N2 metastasis have a favorable outcome.
    No preview · Article · Jan 2009
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    ABSTRACT: A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients undergoing lung resection for non-small cell lung cancer, is lymph node dissection or sampling superior?' Altogether 845 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that in stage I tumours there is little difference in survival when performing either mediastinal lymph node dissection (MLND) or lymph node sampling. However, survival is increased when performing MLND in stage II to IIIa tumours. Increased accuracy in staging is not observed with MLND. However, MLND reliably identifies more positive N2 nodes which may offer advantages in postoperative adjuvant treatment in more advanced disease.
    Full-text · Article · May 2011 · Interactive Cardiovascular and Thoracic Surgery
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