Department of General Thoracic Surgery, Catholic University, Rome, Italy.
Eur J Cardiothorac Surg. 2011 Sep;40(3):656-63. doi: 10.1016/j.ejcts.2010.12.062. Epub 2011 Mar 12.
The surgical treatment of residual N2 disease following induction radio-chemotherapy (IT) for locally advanced cIIIA-N2 non-small-cell lung cancer (NSCLC) is still debated. The long-term results after resection in a pN2 series are at the focus of this study.
From January 1992 to December 2008, 161 consecutive pathologically proven Stage IIIA-N2 NSCLC patients underwent IT. Among these, 40 pN2s were included in this retrospective analysis. The associations between the mortality and the disease-free status with potential risk factors were explored by means of the Kaplan-Meier and Cox regression analysis.
Mean age and male/female ratio were 58.7 ± 9.7 years and 36/4, respectively. Twelve patients (30%) showed a clinical partial response and 28 (70%) showed stable disease. There was one (3%) perioperative death and four (10%) major complications. In the total group, the 3- and 5-year survival rates were 24.2% and 19.3%, respectively. The Cox regression analysis suggested that the macroscopic pN2 status proved to be a negative prognostic factor (hazard ratio (HR)=2.8, confidence interval (CI) 95%: 1.1-7.3; p=0.04). The recurrence rate flattened at 30.8% at the 3rd year. Furthermore, the bilobectomy-pneumonectomy group had a risk of relapse 6.9 times higher than the lobectomy group (CI 95%: 2.5-18.8; p < 0.001).
The persistence of disease at the N2 level after IT and surgery for cIIIa-N2 NSCLC does not exclude favorable outcome after resection, in particular in those patients with minor residual disease.
诱导放化疗（IT）后局部晚期 cIIIA-N2 非小细胞肺癌（NSCLC）残留 N2 疾病的手术治疗仍存在争议。本研究重点关注 N2 系列切除后的长期结果。
1992 年 1 月至 2008 年 12 月，连续 161 例经病理证实的 IIIA-N2 期 NSCLC 患者接受 IT。其中，40 例 pN2 患者纳入本回顾性分析。采用 Kaplan-Meier 和 Cox 回归分析探讨潜在危险因素与死亡率和无病状态的关系。
患者平均年龄和男女比例分别为 58.7±9.7 岁和 36/4。12 例（30%）患者表现为临床部分缓解，28 例（70%）患者病情稳定。围手术期死亡 1 例（3%），严重并发症 4 例（10%）。在总组中，3 年和 5 年生存率分别为 24.2%和 19.3%。Cox 回归分析表明，宏观 pN2 状态是一个负预后因素（风险比（HR）=2.8，95%置信区间（CI）：1.1-7.3；p=0.04）。第 3 年时，复发率稳定在 30.8%。此外，肺叶切除加全肺切除术组的复发风险是肺叶切除术组的 6.9 倍（95%CI：2.5-18.8；p<0.001）。
IT 及手术治疗后 cIIIa-N2 NSCLC 患者 N2 水平仍存在疾病残留并不排除切除后的良好预后，特别是残留疾病较少的患者。
