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Eur J Cardiothorac Surg 2005;28:33-38
© 2005 Elsevier Science NL
a Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41100 Modena, Italy
b Department of Pathologic Anatomy and Forensic Medicine, Section of Pathology, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41100 Modena, Italy
Received 9 February 2005; received in revised form 14 March 2005; accepted 15 March 2005.
* Corresponding author. Address: Division of Thoracic Surgery, Policlinico di Modena, Largo del Pozzo 71, 41100 Modena, Italy. Tel.: +39 594 222 257; fax: +39 593 601 59. (Email: u.morandi{at}unimo.it).
Objective: Patients with non-small cell lung cancer (NSCLC) with metastases to ipsilateral mediastinal lymph nodes (N2) are an heterogeneous group of patients as regard to prognosis and treatment. Indication and timing of surgery remain controversial. The present study investigates the prognostic factors, in order to identify homogenous subgroups of patients. Methods: Histologically proven N2-NSCLC patients, who underwent a complete surgical resection were retrospectively reviewed. Clinical and pathological features were reported and analyzed, and survival study was performed. Results: One hundred eighty-three patients were analyzed. Overall 1.3 and 5 years survival rates were, respectively, 70, 35 and 20%, with a median survival time of 24 months. Univariate analysis showed a significant better prognosis for: incidental N2 respect to clinical N2 (5-years 35.4 vs 17.4%); single level lymph node involvement respect to multiple levels (5-years 23.8 vs 14.7%); metastases to superior mediastinal or aortic nodes respect to lower mediastinal nodes (5-years 32 and 24.3 vs 16.3%); right upper lobe tumors with superior mediastinal nodes and left upper lobe tumors with aortic nodes respect to lower lobes tumors with lower mediastinal nodes (5-years 31.8 and 26.9 vs 15.7%). Skip metastases had not a significant survival advantage respect to continuous lymphatic spread. N2 clinical status, the number of levels involved and the two specific patterns of lymphatic spread resulted significant prognostic factors at multivariate analysis. Conclusions: Clinical N2 status, number of lymph nodes levels involved and specific patterns of lymphatic spread identify homogenous subgroups of patients that can be proposed for different therapeutic strategies.
Key Words: Non-small cell lung cancer • N2 • Mediastinal nodal metastases • Prognosis
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