Postoperative Survival Analysis of Patients with Mini Pathological N<sub>2</sub> Non-small Cell Lung Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGShao-hua ¹ , HUANGDa-yu ¹ , YUDong-yi ² , XUDong ³ , FANGYu-chao ² ,  CHENXiao-feng ¹

1. Department of Thoracic Surgery, Huashan Hospital Affiliated to Fudan University, Shanghai 200030, P. R. China;
2. Medical School, Tongji University, Shanghai 200092, P. R. China;
3. Medical School, Suzhou University, Suzhou 215123, Jiangsu, P. R. China;

Corresponding author：

CHENXiao-feng, Email: Dr_chenxiaofeng@126.com

Keywords：

Non-small cell lung cancer; Staging; Surgery; Prognosis

DOI：

10.7507/1007-4848.20150015

Video：

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Objective To explore prognostic factors of non-small cell lung cancer(NSCLC)patients with preoperative clinical N0 staging but unexpected postoperative pathological N₂ staging (cN₀-pN₂). Methods Clinical data of NSCLC patients with cN₀-pN₂ after radical lung cancer resection in Huashan Hospital Affiliated to Fudan University from January 2006 to December 2010 were retrospectively analyzed. Survival information was collected through followup, and follow-up expired on December 31, 2012. Prognostic factors of NSCLC patients with cN₀-pN₂ were analyzed using Cox proportional-hazard regression. Results A total of 263 patients were enrolled in this study. The followup rate was 91.63%. Overall 1-year, 3-year and 5-year survival rate was 94.6%, 55.2% and 26.3%, respectively. Videoassisted thoracoscopic surgery (VATS, P=0.017, RR=0.659, 95%CI 0.469-0.927), multiple stations of mediastinal lymph node metastases (P=0.003, RR=1.605, 95%CI 1.180-2.183), no adjuvant chemotherapy(P=0.012, RR=1.576, 95%CI 1.105-2.246) were independent predictive factors for NSCLC patients with cN₀-pN₂. For patients with single station N₂, median survival after VATS was significantly longer than that after open thoracotomy (48.55 months vs. 37.34 months, P=0.018). For patients with multiple stations of mediastinal lymph node metastases, median survival without any adjuvant chemotherapy was significantly shorter than that after adjuvant chemotherapy (20.32 months vs. 31.55 months, P=0.001). Conclusion Prognosis of NSCLC patients with cN₀-pN₂ is related to operational methods, adjuvant chemotherapy and station number of mediastinal lymph node metastasis. Patients with single station of mediastinal lymph node metastasis are more likely to benefit from VATS while patients with multiple stations of mediastinal lymph node metastases are more likely to benefit from adjuvant chemotherapy.

Citation： WANGShao-hua, HUANGDa-yu, YUDong-yi, XUDong, FANGYu-chao, CHENXiao-feng. Postoperative Survival Analysis of Patients with Mini Pathological N₂ Non-small Cell Lung Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 49-53. doi: 10.7507/1007-4848.20150015 Copy

1.	Decaluwé H, De Leyn P, Vansteenkiste J, et al. Surgical multimodality treatment for baseline resectable stage ⅢA-N₂ non-small cell lung cancer. Degree of mediastinal lymph node involvement and impact on survival. Eur J Cardiothorac Surg, 2009, 36(3):433-439.
2.	Kim HK, Choi YS, Kim J, et al. Outcomes of unexpected pathologic N1 and N₂ disease after video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung Cancer. J Thorac Cardiovasc Surg, 2010, 140(6):1288-1293.
3.	Iskender I, Kapicibasi HO, Kadioglu SZ, et al. Comparison of integrated positron emission tomography/computed tomography and mediastinoscopy in mediastinal staging of non-small cell lung cancer:analysis of 212 patients. Acta Chir Belg, 2012, 112(3):219-225.
4.	Lee BE, Kletsman E, Rutledge JR, et al. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg, 2012, 143(3):585-590.
5.	Nakanishi R, Osaki T, Nakanishi K, et al. Treatment strategy for patients with surgically discovered N₂ stage ⅢA non-small cell lung cancer. Ann Thorac Surg, 1997, 64(2):342-348.
6.	Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N₂ (stage ⅢA)nonsmall-cell lung cancer. Ann Thorac Surg, 2008, 86(2):362-367.
7.	Detterbeck F. What to do with "Surprise" N₂?:intraoperative management of patients with non-small cell lung cancer. J Thorac Oncol, 2008, 3(3):289-302.
8.	Lorent N, De Leyn P, Lievens Y, et al. Long-term survival of surgically staged ⅢA-N₂ non-small-cell lung cancer treated with surgical combined modality approach:analysis of a 7-year prospective experience. Ann Oncol, 2004, 15(11):1645-1653.
9.	Riquet M, Hidden G, Debesse B. Direct lymphatic drainage of lung segments to the mediastinal nodes. An anatomic study on 260 adults. J Thorac Cardiovasc Surg, 1989, 97(4):623-632.
10.	Junker K, Gumprich T, Müller KM.[Discontinuous lymph node metastases("skipping") in malignant lung tumors]. Chirurg, 1997, 68(6):596-600.
11.	Friedel G, Linder A, Pfeiffer S, et al. Radical lung surgery interventions with special reference to lymphadenectomy. Langenbecks Arch Chir Suppl Kongressbd, 1996, 113:785-789.
12.	Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg, 2000, 24(1):27-31.
13.	Gabor S, Renner H, Popper H, et al. Invasion of blood vessels as significant prognostic factor in radically resected T1-3N0M0 nonsmall-cell lung cancer. Eur J Cardiothorac Surg, 2004, 25(3):439-442.
14.	周文勇, 陈晓峰, 张雷, 等. 微小N₂非小细胞肺癌胸腔镜肺叶切除与同期开胸手术对照研究. 中华外科杂志, 2011, 49(9):820-824.
15.	Maeda R, Yoshida J, Ishii G, et al. Prognostic impact of intratumoral vascular invasion in non-small cell lung cancer patients. Thorax, 2010, 65(12):1092-1098.
16.	Arriaqada R, Berqman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med, 2004, 350(4):351-360.
17.	Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation:a pooled analysis by the LACE collaborative group. J clin oncol, 2008, 26(21):3552-3559.
18.	Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med, 2005, 352(25):2589-2597.
19.	Waller D, Peake MD, Stephens RJ, et al. Chemotherapy for patients with non-small cell lung cancer:the surgical setting of the big lung trial. Eur J Cardiothorac Surg, 2004, 26(1):173-182.

1. Decaluwé H, De Leyn P, Vansteenkiste J, et al. Surgical multimodality treatment for baseline resectable stage ⅢA-N₂ non-small cell lung cancer. Degree of mediastinal lymph node involvement and impact on survival. Eur J Cardiothorac Surg, 2009, 36(3):433-439.
2. Kim HK, Choi YS, Kim J, et al. Outcomes of unexpected pathologic N1 and N₂ disease after video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung Cancer. J Thorac Cardiovasc Surg, 2010, 140(6):1288-1293.
3. Iskender I, Kapicibasi HO, Kadioglu SZ, et al. Comparison of integrated positron emission tomography/computed tomography and mediastinoscopy in mediastinal staging of non-small cell lung cancer:analysis of 212 patients. Acta Chir Belg, 2012, 112(3):219-225.
4. Lee BE, Kletsman E, Rutledge JR, et al. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg, 2012, 143(3):585-590.
5. Nakanishi R, Osaki T, Nakanishi K, et al. Treatment strategy for patients with surgically discovered N₂ stage ⅢA non-small cell lung cancer. Ann Thorac Surg, 1997, 64(2):342-348.
6. Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N₂ (stage ⅢA)nonsmall-cell lung cancer. Ann Thorac Surg, 2008, 86(2):362-367.
7. Detterbeck F. What to do with "Surprise" N₂?:intraoperative management of patients with non-small cell lung cancer. J Thorac Oncol, 2008, 3(3):289-302.
8. Lorent N, De Leyn P, Lievens Y, et al. Long-term survival of surgically staged ⅢA-N₂ non-small-cell lung cancer treated with surgical combined modality approach:analysis of a 7-year prospective experience. Ann Oncol, 2004, 15(11):1645-1653.
9. Riquet M, Hidden G, Debesse B. Direct lymphatic drainage of lung segments to the mediastinal nodes. An anatomic study on 260 adults. J Thorac Cardiovasc Surg, 1989, 97(4):623-632.
10. Junker K, Gumprich T, Müller KM.[Discontinuous lymph node metastases("skipping") in malignant lung tumors]. Chirurg, 1997, 68(6):596-600.
11. Friedel G, Linder A, Pfeiffer S, et al. Radical lung surgery interventions with special reference to lymphadenectomy. Langenbecks Arch Chir Suppl Kongressbd, 1996, 113:785-789.
12. Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg, 2000, 24(1):27-31.
13. Gabor S, Renner H, Popper H, et al. Invasion of blood vessels as significant prognostic factor in radically resected T1-3N0M0 nonsmall-cell lung cancer. Eur J Cardiothorac Surg, 2004, 25(3):439-442.
14. 周文勇, 陈晓峰, 张雷, 等. 微小N₂非小细胞肺癌胸腔镜肺叶切除与同期开胸手术对照研究. 中华外科杂志, 2011, 49(9):820-824.
15. Maeda R, Yoshida J, Ishii G, et al. Prognostic impact of intratumoral vascular invasion in non-small cell lung cancer patients. Thorax, 2010, 65(12):1092-1098.
16. Arriaqada R, Berqman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med, 2004, 350(4):351-360.
17. Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation:a pooled analysis by the LACE collaborative group. J clin oncol, 2008, 26(21):3552-3559.
18. Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med, 2005, 352(25):2589-2597.
19. Waller D, Peake MD, Stephens RJ, et al. Chemotherapy for patients with non-small cell lung cancer:the surgical setting of the big lung trial. Eur J Cardiothorac Surg, 2004, 26(1):173-182.

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Postoperative Survival Analysis of Patients with Mini Pathological N₂ Non-small Cell Lung Cancer

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Postoperative Survival Analysis of Patients with Mini Pathological N₂ Non-small Cell Lung Cancer