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The Prognosis According to Patterns of Mediastinal Lymph Node Metastasis in Pathologic Stage IIIA/N2 Non-Small Cell Lung Cancer.

Kim do W, Yun JS, Song SY, Na KJ - Korean J Thorac Cardiovasc Surg (2014)

Bottom Line: A univariate analysis showed that age, pathologic T stage, and adjuvant chemotherapy were significant prognostic factors, while in multivariate analysis, pathologic T stage and adjuvant chemotherapy were significant prognostic factors.Further, non-regional MLN metastasis was associated with a higher loco-regional recurrence rate.These results may be helpful for planning postoperative therapeutic strategies and predicting outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Korea.

ABSTRACT

Background: The aim of this study is to evaluate prognostic factors for survival in pathologic stage IIIA/N2 non-small-cell lung cancer (NSCLC), to identify the prognostic significance of the metastatic patterns of mediastinal lymph nodes (MLNs) relating to survival and to recurrence and metastasis.

Methods: A total of 129 patients who underwent radical resection for pathologic stage IIIA-N2 NSCLC from July 1998 to April 2011 were retrospectively reviewed. The end points of this study were rates of loco-regional recurrence and distant metastasis, and survival.

Results: The overall 5-year survival rate was 47.4%. A univariate analysis showed that age, pathologic T stage, and adjuvant chemotherapy were significant prognostic factors, while in multivariate analysis, pathologic T stage and adjuvant chemotherapy were significant prognostic factors. The metastasis rate was higher in patients with multistation N2 involvement and with more than 3 positive MLNs. Further, non-regional MLN metastasis was associated with a higher loco-regional recurrence rate.

Conclusion: Pathologic T stage and adjuvant chemotherapy were independent prognostic factors for long-term survival in pathologic stage IIIA/N2 NSCLC. The recurrence and the metastasis rate were affected by the metastatic patterns of MLNs. These results may be helpful for planning postoperative therapeutic strategies and predicting outcomes.

No MeSH data available.


Related in: MedlinePlus

Survival curve of patients with positive highest mediastinal lymph node according to (postoperative) adjuvant treatment (chemotherapy or combined therapy).
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Related In: Results  -  Collection

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Figure 3: Survival curve of patients with positive highest mediastinal lymph node according to (postoperative) adjuvant treatment (chemotherapy or combined therapy).

Mentions: The clinical characteristics of the patients are shown in Table 1. The mean age of the patients was 62.1 years (range, 35 to 83 years), and 88 of the patients (68%) were male. The distribution of MLN metastasis is presented in Table 2. Two hospital deaths (1.6%) occurred; pneumonia was the cause of death in both cases. The overall survival rates for the patients were as follows: 1 year, 80.6%; 3 years, 57.0%; and 5 years, 47.4%. During the follow-up period, 36 patients had a local recurrence, a distant metastasis was identified in 64 cases, and both recurrence and metastasis occurred in 14 cases. The most common local recurrence site was the MLNs in 18 cases, the ipsilateral lung in 15 cases, and the bronchial stump in 6 cases. The brain was the most common site of distant metastasis (26 cases), followed by the contralateral lung (15 cases), and bone (11 cases). A univariate survival analysis was performed (Tables 1, 2). Sex, location of tumor, the presence or absence of pneumonectomy, and histological differentiation or classification did not differ significantly between the groups. The 5-year survival rate was 51.1% for patients aged <70 years and 18.9% for those aged >70 years (p=0.034) (Fig. 1A). With respect to the pathological T stage, since only a few patients (n=18) with T3 stage were included, we combined the patients with T2 stage and T3 stage into a single high risk group and analyzed them together. The 5-year survival rate in group T1 was 65.7% as compared to 41.5% in group T2-3 (p=0.012) (Fig. 1B). Sixty-nine patients were treated by chemotherapy, and 55 patients were treated by radiotherapy or combined therapy. Five patients were not treated with adjuvant therapy due to the patients' refusal or poor general condition. We analyzed these patients by dividing them into two groups: a group that was treated by only chemotherapy (n=69) and a group that underwent a treatment other than chemotherapy (n=55). The five-year survival rate among patients who received adjuvant chemotherapy after surgery was 62.3%; that for patients who received another treatment was 34.6% (p=0.004) (Fig. 1C). With respect to the patterns of MLN metastasis, in all cases, there was no significant difference in survival. However, among the patients with upper lobe cancer, the 5-year survival rate was significantly higher in patients with regional metastasis (53.9% vs. 27.3%, p=0.043) (Fig. 2). In a multivariate analysis, pathologic T stage and adjuvant chemotherapy were significant prognostic factors for survival (Table 3). The incidences of local recurrence and distant metastasis were different according to the pattern of lymph node metastasis (Table 4). Distant metastasis was more likely in cases involving multiple MLN stations (p=0.042) or three or more positive MLNs (p=0.016). Additionally, the non-regional lymph node metastasis group showed a higher frequency of local recurrence than the regional lymph node metastasis group (p=0.023). The highest MLN was identified in 52 patients and was targeted for additional analysis. Twenty-four patients were treated only with chemotherapy, and 17 patients were treated with combined therapy. In a comparison of the 5-year survival rate (67.7% vs. 47.2%, p=0.300), local recurrence rate (37.5% vs. 25.0%, p=0.408), and incidence of distant metastasis (58.3% vs. 50.0%, p=0.604) between patients who underwent adjuvant chemotherapy and patients who were treated with chemotherapy and radiation therapy, no significant difference was found (Fig. 3).


The Prognosis According to Patterns of Mediastinal Lymph Node Metastasis in Pathologic Stage IIIA/N2 Non-Small Cell Lung Cancer.

Kim do W, Yun JS, Song SY, Na KJ - Korean J Thorac Cardiovasc Surg (2014)

Survival curve of patients with positive highest mediastinal lymph node according to (postoperative) adjuvant treatment (chemotherapy or combined therapy).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928257&req=5

Figure 3: Survival curve of patients with positive highest mediastinal lymph node according to (postoperative) adjuvant treatment (chemotherapy or combined therapy).
Mentions: The clinical characteristics of the patients are shown in Table 1. The mean age of the patients was 62.1 years (range, 35 to 83 years), and 88 of the patients (68%) were male. The distribution of MLN metastasis is presented in Table 2. Two hospital deaths (1.6%) occurred; pneumonia was the cause of death in both cases. The overall survival rates for the patients were as follows: 1 year, 80.6%; 3 years, 57.0%; and 5 years, 47.4%. During the follow-up period, 36 patients had a local recurrence, a distant metastasis was identified in 64 cases, and both recurrence and metastasis occurred in 14 cases. The most common local recurrence site was the MLNs in 18 cases, the ipsilateral lung in 15 cases, and the bronchial stump in 6 cases. The brain was the most common site of distant metastasis (26 cases), followed by the contralateral lung (15 cases), and bone (11 cases). A univariate survival analysis was performed (Tables 1, 2). Sex, location of tumor, the presence or absence of pneumonectomy, and histological differentiation or classification did not differ significantly between the groups. The 5-year survival rate was 51.1% for patients aged <70 years and 18.9% for those aged >70 years (p=0.034) (Fig. 1A). With respect to the pathological T stage, since only a few patients (n=18) with T3 stage were included, we combined the patients with T2 stage and T3 stage into a single high risk group and analyzed them together. The 5-year survival rate in group T1 was 65.7% as compared to 41.5% in group T2-3 (p=0.012) (Fig. 1B). Sixty-nine patients were treated by chemotherapy, and 55 patients were treated by radiotherapy or combined therapy. Five patients were not treated with adjuvant therapy due to the patients' refusal or poor general condition. We analyzed these patients by dividing them into two groups: a group that was treated by only chemotherapy (n=69) and a group that underwent a treatment other than chemotherapy (n=55). The five-year survival rate among patients who received adjuvant chemotherapy after surgery was 62.3%; that for patients who received another treatment was 34.6% (p=0.004) (Fig. 1C). With respect to the patterns of MLN metastasis, in all cases, there was no significant difference in survival. However, among the patients with upper lobe cancer, the 5-year survival rate was significantly higher in patients with regional metastasis (53.9% vs. 27.3%, p=0.043) (Fig. 2). In a multivariate analysis, pathologic T stage and adjuvant chemotherapy were significant prognostic factors for survival (Table 3). The incidences of local recurrence and distant metastasis were different according to the pattern of lymph node metastasis (Table 4). Distant metastasis was more likely in cases involving multiple MLN stations (p=0.042) or three or more positive MLNs (p=0.016). Additionally, the non-regional lymph node metastasis group showed a higher frequency of local recurrence than the regional lymph node metastasis group (p=0.023). The highest MLN was identified in 52 patients and was targeted for additional analysis. Twenty-four patients were treated only with chemotherapy, and 17 patients were treated with combined therapy. In a comparison of the 5-year survival rate (67.7% vs. 47.2%, p=0.300), local recurrence rate (37.5% vs. 25.0%, p=0.408), and incidence of distant metastasis (58.3% vs. 50.0%, p=0.604) between patients who underwent adjuvant chemotherapy and patients who were treated with chemotherapy and radiation therapy, no significant difference was found (Fig. 3).

Bottom Line: A univariate analysis showed that age, pathologic T stage, and adjuvant chemotherapy were significant prognostic factors, while in multivariate analysis, pathologic T stage and adjuvant chemotherapy were significant prognostic factors.Further, non-regional MLN metastasis was associated with a higher loco-regional recurrence rate.These results may be helpful for planning postoperative therapeutic strategies and predicting outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Korea.

ABSTRACT

Background: The aim of this study is to evaluate prognostic factors for survival in pathologic stage IIIA/N2 non-small-cell lung cancer (NSCLC), to identify the prognostic significance of the metastatic patterns of mediastinal lymph nodes (MLNs) relating to survival and to recurrence and metastasis.

Methods: A total of 129 patients who underwent radical resection for pathologic stage IIIA-N2 NSCLC from July 1998 to April 2011 were retrospectively reviewed. The end points of this study were rates of loco-regional recurrence and distant metastasis, and survival.

Results: The overall 5-year survival rate was 47.4%. A univariate analysis showed that age, pathologic T stage, and adjuvant chemotherapy were significant prognostic factors, while in multivariate analysis, pathologic T stage and adjuvant chemotherapy were significant prognostic factors. The metastasis rate was higher in patients with multistation N2 involvement and with more than 3 positive MLNs. Further, non-regional MLN metastasis was associated with a higher loco-regional recurrence rate.

Conclusion: Pathologic T stage and adjuvant chemotherapy were independent prognostic factors for long-term survival in pathologic stage IIIA/N2 NSCLC. The recurrence and the metastasis rate were affected by the metastatic patterns of MLNs. These results may be helpful for planning postoperative therapeutic strategies and predicting outcomes.

No MeSH data available.


Related in: MedlinePlus