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Ann Thorac Surg. 2014 Jun;97(6):1920-5. doi: 10.1016/j.athoracsur.2014.03.004. Epub 2014 Apr 24.

Modern outcome and risk analysis of surgically resected occult N2 non-small cell lung cancer.

Author information

1
Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, Korea.
2
Department of Thoracic and Cardiovascular Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3
Department of Thoracic and Cardiovascular Surgery, Seoul Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: scena@dreamwiz.com.
4
Department of Preventive Medicine, Graduate School of Medicine, Gachon University, Incheon, Korea.

Abstract

BACKGROUND:

This study was performed to assess the incidence, survival, and risk factors associated with unsuspected pathologic N2 disease in patients with resectable clinical N0-1 non-small cell lung cancer.

METHODS:

Between January 2002 and December 2010, 1,821 patients with clinical N0-1 non-small cell lung cancer underwent pulmonary resection and mediastinal lymph node dissection. Clinical outcomes and risk factors for pathologic N2 disease were retrospectively analyzed for this cohort.

RESULTS:

Unsuspected pathologic N2 disease was identified in 196 patients (10.8%). The most common type of resection was lobectomy (81.6%). Adjuvant therapy was administered in 177 patients (90.3%). The median follow-up time was 28 months (range, 1 to 101 months). N2 involvement was single-station in 121 (66.8%) and multiple-station in 65 (33.2%). The 5-year overall and disease-free survival rates were 56.1% and 35.0%, respectively. The 5-year survival rates of single-station and multiple-station N2 were 66.6% and 36.4%, respectively (p < 0.001). Adenocarcinoma, clinical N1, tumor size (>3 cm), and a right middle lobe tumor were identified as independent risk factors for unsuspected multiple-station N2 disease by multivariate analysis. Incidence of unsuspected multiple-station N2 disease in low-risk classes (aggregate score, 0 to ≤2) was only 5.5%.

CONCLUSIONS:

The incidence of unsuspected N2 disease in our cohort was similar to that of previous reports. Survival outcomes were favorable for unsuspected single-station N2 disease but were poor for unsuspected multiple-station N2 disease. Clinical N0-1 non-small cell lung cancer patients with risk class of low score for unsuspected multiple-station N2 disease can be exempted from aggressive mediastinal staging.

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