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Pathologic N1 non-small cell lung cancer: Correlation between pattern of lymphatic spread and prognosis
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 125(3):543-553
- Publication Year :
- 2003
- Publisher :
- Elsevier BV, 2003.
-
Abstract
- Objectives: Patients with N1 non-small cell lung cancer represent a heterogeneous population with varying long-term survivals. Prognosis and pattern of recurrence seem to be particularly affected by the level of lymph node involvement. Methods: From 1990 to 1995, a total of 1954 consecutive patients underwent surgical resection for non-small cell lung cancer: 549 (28%) had ipsilateral pulmonary lymph node metastases (N1). The hospital survivors (n = 535) were reviewed. Three levels of lymph node metastases (hilar, interlobar, and lobar) were identified according to the new Regional Lymph Node Classification for Lung Cancer Staging and differentiated from lymph node involvement on the basis of direct invasion. Results: 1 The overall 5-year survival of patients with N1 disease was 40%. Survival was related in the univariate analysis to T classification, level-type of N1 involvement, number of involved nodes, multilevel involvement, Karnofsky Index, R status, and adjuvant therapy. In the multivariate analysis, only T classification and level-type of N1 involvement clearly showed statistical power ( P =.000 and P =.001, respectively). The pattern of cancer relapse according to level-type of N1 involvement differed significantly: hilar N1 disease recurred at distant sites in 41% of patients and locoregionally in 12% of patients, whereas N1 disease by direct invasion occurred in 24% and 17% of patients, respectively ( P =.030). Conclusions: Metastases to ipsilateral hilar, interlobar, or both, lymph nodes are associated with a poorer prognosis compared with metastases in intralobar lymph nodes or with lymph node involvement by means of direct invasion. Although surgical resection remains the mainstay of treatment, the high rate of tumor recurrence in both groups mandates further randomized studies with multimodality therapy approaches. J Thorac Cardiovasc Surg 2003;125;543-53
- Subjects :
- Adult
Male
Pulmonary and Respiratory Medicine
Pathology
medicine.medical_specialty
Lung Neoplasms
Metastasis
Carcinoma, Non-Small-Cell Lung
Forced Expiratory Volume
Germany
medicine
Adjuvant therapy
Humans
Karnofsky Performance Status
Pneumonectomy
Lung cancer
Lymph node
Aged
Neoplasm Staging
Retrospective Studies
Aged, 80 and over
Analysis of Variance
Univariate analysis
business.industry
Respiratory disease
Middle Aged
Prognosis
medicine.disease
Survival Analysis
Treatment Outcome
medicine.anatomical_structure
Lymphatic Metastasis
Female
Surgery
Lymph
Radiology
Neoplasm Recurrence, Local
Lung cancer staging
business
Cardiology and Cardiovascular Medicine
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 125
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....511de6a4fa09d9a72605a3ea72c53d94
- Full Text :
- https://doi.org/10.1067/mtc.2003.322