Fujimoto Toshio, Cassivi Stephen D, Yang Ping, Barnes Sunni A, Nichols Francis C, Deschamps Claude, Allen Mark S, Pairolero Peter C
Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
J Thorac Cardiovasc Surg. 2006 Sep;132(3):499-506. doi: 10.1016/j.jtcvs.2006.04.019. Epub 2006 Jul 28.
N1 disease in non-small cell lung cancer represents a heterogeneous patient subgroup with a 5-year survival of approximately 40%. Few reports have evaluated the correlation between N1 disease and tumor recurrence or which subgroup of patients would most benefit from adjuvant chemotherapy.
From 1997 through 2002, all patients with pathologic T1-4 N1 M0 non-small cell lung cancer who had a complete resection with systematic mediastinal lymphadenectomy were retrospectively analyzed and evaluated for factors associated with recurrence and long-term survival.
One hundred eighty patients with N1 disease were evaluated. Sixty-six (37%) patients had either locoregional recurrence (n = 39 [22%]), distant metastasis (n = 41 [23%]), or both during follow-up. Univariate analysis demonstrated that visceral pleural invasion and age were associated with locoregional recurrence, whereas visceral pleural invasion, distinct N1 metastasis (as opposed to direct N1 invasion by the primary tumor), and multistation lymph node involvement were associated with distant metastasis (P < .05). Multivariable analysis demonstrated that visceral pleural invasion, multistation N1 involvement, and distinct N1 metastasis were the only independent predisposing factors for locoregional recurrence and distant metastasis. Overall 5-year survival was 42.5%. Survival was significantly decreased by advanced pathologic T classification (P = .015), visceral pleural invasion (P < .0001), and higher tumor grade (P = .014).
In patients with N1-positive non-small cell lung cancer, visceral pleural invasion, multistation N1 disease, and distinct N1 metastasis are independent predictors of subsequent locoregional recurrence and distant metastasis. Advanced T classification, visceral pleural invasion, and higher tumor grade were predictors of poor survival. These patients represent a subgroup of patients with N1 disease who might benefit from additional therapy, including adjuvant chemotherapy.
非小细胞肺癌中的N1期疾病代表了一个异质性患者亚组，其5年生存率约为40%。很少有报告评估N1期疾病与肿瘤复发之间的相关性，或哪些患者亚组最能从辅助化疗中获益。
对1997年至2002年期间所有经病理证实为T1-4 N1 M0期非小细胞肺癌且接受了系统性纵隔淋巴结清扫的完全切除术患者进行回顾性分析，并评估与复发和长期生存相关的因素。
对180例N1期疾病患者进行了评估。66例（37%）患者在随访期间出现了局部区域复发（n = 39 [22%]）、远处转移（n = 41 [23%]）或两者皆有。单因素分析表明，脏层胸膜侵犯和年龄与局部区域复发相关，而脏层胸膜侵犯、明确的N1转移（与原发肿瘤直接侵犯N1相反）和多站淋巴结受累与远处转移相关（P <.05）。多变量分析表明，脏层胸膜侵犯、多站N1受累和明确的N1转移是局部区域复发和远处转移的唯一独立易感因素。总体5年生存率为42.5%。生存情况因病理T分期进展（P =.015）、脏层胸膜侵犯（P <.0001）和肿瘤分级较高（P =.014）而显著降低。
在N1阳性的非小细胞肺癌患者中,脏层胸膜侵犯、多站N1期疾病和明确的N1转移是随后局部区域复发和远处转移的独立预测因素。T分期进展、脏层胸膜侵犯和肿瘤分级较高是生存不良的预测因素。这些患者代表了N1期疾病患者中可能从包括辅助化疗在内的额外治疗中获益的一个亚组。
