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Eur J Cardiothorac Surg 2004;25:1114-1120
© 2004 Elsevier Science NL

Skip mediastinal nodal metastases in non-small cell lung cancer

^a Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, Shogoin-kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
^b Department of Translational Clinical Oncology, Kyoto University, Kyoto, Japan
^c Department of Thoracic Surgery, Seishin-iryo Center Hospital, Kobe, Japan
^d Department of Radiology, Fukui Medical University, Fukui, Japan

Received 6 October 2003; received in revised form 25 February 2004; accepted 1 March 2004.

^* Corresponding author. Tel.: +81-75-751-4975; fax: +81-75-751-4974
e-mail: ftanaka{at}kuhp.kyoto-u.ac.jp

Objective: To reveal the incidence and clinical significance of mediastinal nodal metastases without N1-station nodal metastases (‘skip-N2 metastases’) in non-small cell lung cancer (NSCLC). Methods: A total of 450 NSCLC patients who underwent tumor resection with a systemic mediastinal nodal dissection were retrospectively reviewed. p53 status and proliferative activity represented as proliferative index (PI) were also examined immunohistochemically. Results: Skip-N2 metastases were documented in 49 (13%) patients of all 450 patients; among 334 patients without N1-nodal involvement, 18% patients had skip-N2 metastases. The postoperative survival of skip-N2 patients was almost same as that for patients with metastases to both N1 and N2 nodes. Skip-N2 metastases were significantly more frequent in male patients and squamous cell carcinoma patients. In addition, the mean PI for tumor with skip-N2 metastases was significantly higher than that for any other pathologic nodal (pN)-status diseases. Combined with histologic type and PI, the incidences of skip-N2 metastases for adenocarcinoma showing lower PI were only 5% (7/137) of all patients and 7% (7/94) of patients without N1-nodal involvement. Conclusions: N1 nodal status is not a useful predictor of N2 nodal status in NSCLC, because skip-N2 metastases were documented in 18% patients showing no N1-nodal involvement. However, N1 node-guided dissection might be performed in patients with adenocarcinoma showing lower PI, because the incidence of skip-N2 metastases was extremely low.

Key Words: Non-small cell lung cancer • Mediastinal nodal metastases • N2 • Skip metastases • Prognosis • Biomarker