J Korean Med Sci.  2008 Aug;23(4):604-608. 10.3346/jkms.2008.23.4.604.

The Prognostic Significance of Multiple Station N2 in Patients with Surgically Resected Stage IIIA N2 Non-small Cell Lung Cancer

• Lee JG
• Lee CY
• Park IK
• Kim DJ
• Cho SH
• Kim KD
• Chung KY

• KMID: 1785817
• DOI: http://doi.org/10.3346/jkms.2008.23.4.604

Abstract

Mediastinal (N2) lymph node involvement is heterogenous with huge variation in the extent and grouped together under stage IIIA. However, they showed a different survival even in the same stage. We tried to determine the prognostic implication of the multiple station N2 lymph node metastasis in stage IIIA N2 non-small cell lung cancer (NSCLC). The survival of stage IIIA N2 was analyzed according to the number of N2 station and their survival was compared with that of stage IIIB. In stage IIIA N2 NSCLC, multivariate analysis indicated that multiple station N2 was one of the independent prognostic factors for poor survival. The 5-yr survival of multiple station N2 IIIA (20.4%) was lower than that of single station N2 IIIA (33.8%) significantly (p=0.016). but when it was compared with that of stage IIIB (15.5%), there was no difference. Therefore, we suggest that multiple station N2 should be considered similar to stage IIIB disease with regard to predicting survival and accordingly should receive a new position in the TNM staging system.

Keyword

Lung Neoplasms; Lymph Node, Neoplasm Metastasis; Prognosis

MeSH Terms

Adult
Aged
Carcinoma, Non-Small-Cell Lung/*mortality/pathology
Female
Humans
Lung Neoplasms/*mortality/pathology
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Prognosis
Survival Rate

Figure

• 

  Fig. 1 Overall survival curves of patients with stage IIIA N2 and stage IIIB NSCLC.

• 

  Fig. 2 Overall survival curves of patients with single station N2, multiple station N2, and stage IIIB NSCLC.

Reference

1. Naruke T, Tsuchiya R, Kondo H, Asamura H. Prognosis and survival after resection for bronchogenic carcinoma based on the 1997 TNM-staging classification: the Japanese experience. Ann Thorac Surg. 2001. 71:1759–1764.

2. Keller SM, Adak S, Wagner H, Johnson DH. Mediastinal lymph node dissection improves survival in patients with stage II and IIIA non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg. 2000. 70:358–366.

3. Grunenwald D, Le Chevalier T. Re: Stage IIIA category of non-small cell lung cancer: a new proposal. J Natl Cancer Inst. 1997. 89:88–89.

4. Pearson FG, Delarue NC, Ilves R, Todd TR, Cooper JD. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg. 1982. 83:1–11.

5. Andre F, Grunenwald D, Pignon JP, Dujon A, Pujol JL, Brichon PY, Brouchet L, Quoix E, Westeel V, Le Chevalier T. Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol. 2000. 18:2981–2989.

6. Ruckdeschel JC. Combined modality therapy of non-small cell lung cancer. Semin Oncol. 1997. 24:429–439.

7. Osaki T, Nagashima A, Yoshimatsu T, Tashima Y, Yasumoto K. Survival and characteristics of lymph node involvement in patients with N1 non-small cell lung cancer. Lung cancer. 2004. 43:151–157.

8. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest. 1997. 111:1718–1723.

9. Mountain CF. Revisions in the international system for staging lung cancer. Chest. 1997. 111:1710–1717.

10. Watanabe Y, Hayashi Y, Shimizu J, Oda M, Iwa T. Mediastinal nodal involvement and prognosis of non-small cell lung cancer. Chest. 1991. 100:422–428.

11. Ichinose Y, Kato H, Koike T, Tsuchiya R, Fujisawa T, Shimizu N, Watanabe Y, Mitsudomi T, Yoshimura M, Tsuboi M; Japanese Clinical Oncology Group. Completely resected stage IIIA non-small cell lung cancer: the significance of primary tumor location and N2 station. J Thorac Cardiovasc Surg. 2001. 122:803–808.

12. Inoue M, Sawabata N, Takeda S, Ohta M, Ohno Y, Maeda H. Results of surgical intervention for p-stage IIIA (N2) non small cell lung cancer: acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in the upper lobe. J Thorac Cardiovasc Surg. 2004. 127:1100–1106.

13. Riquet M, Assouad J, Bagan P, Foucault C, Barthes F, Dujon A, Danel C. Skip mediastinal lymph node metastasis and lung cancer: a particular N2 subgroup with a better prognosis. Ann Thorac Surg. 2005. 79:225–233.

14. Martini N, Flehinger B. The role of surgery in N2 lung cancer. Surg Clin North Am. 1987. 67:1037–1049.

15. Naruke T, Goya T, Tsuchiya R, Suemasu K. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg. 1988. 46:603–610.

16. Mountain CF. Surgery for stage IIIa-N2 non-small cell lung cancer. Cancer. 1994. 73:2589–2598.

17. Vansteenkiste JF, Leyn PR, Deneffe GR, Lerut TE, Demedts MG. Clinical prognostic factors in surgically treated stage IIIA-N2 nonsmall cell lung cancer: analysis of the literature. Lung Cancer. 1998. 19:3–13.

18. Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, Cormier Y, Goss G, Inculet R, Vallieres E, Fry W, Bethune D, Ayoub J, Ding K, Seymour L, Graham B, Tsao MS, Gandara D, Kesler K, Demmy T, Shepherd F; National Cancer Institute of Canada Clinical Trials Group; National Cancer Institute of the United States Intergroup JBR.10 Trial Investigators. Vinorelbine plus cisplatin vs observation in resected non-smallcell lung cancer. N Engl J Med. 2005. 352:2589–2597.

19. Douillard J, Rosell R, Delena M, Legroumellec A, Torres A, Carpagnano F. ANITA: Phase III adjuvant vinorelbine and cisplatin versus observation in completely resected (stage I-III) non small cell lung cancer (NSCLC) patients: Final results after 70-month median follow-up, On behalf of the Adjuvant Navelbine International Trialists Association. J Clin Oncol. 2005. 23:624. (Suppl; abstr 7013).

20. Murray JG, O'Driscoll M, Curtin JJ. Mediastinal lymph node size in an Asian population. Br J Radiol. 1995. 68:348–350.

21. Arita T, Matsumoto T, Kuramitsu T, Kawamura M, Matsunaga N, Sugi K, Esato K. Is it possible to differentiate malignant mediastinal nodes from benign nodes by size? Reevaluation by CT, transesophageal echocardiography and nodal specimen. Chest. 1996. 110:1004–1008.