Matsunaga Takeshi, Suzuki Kenji, Takamochi Kazuya, Oh Shiaki
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
Eur J Cardiothorac Surg. 2014 Jul;46(1):86-91. doi: 10.1093/ejcts/ezt550. Epub 2013 Dec 8.
The number of stations of N2 nodes involved has been considered to be one of the most important prognostic factors for lung cancer. However, most reports have dealt with the pathological nodal status rather than with the clinical nodal status. We investigated the relationship between the prognosis and the location of the primary tumour and nodes involved.
A retrospective study was conducted in 1257 patients with primary lung cancer, which were resected between 1996 and 2009. Among them, 78 patients (6.2%) had cN2, c-stage IIIA, pN2 and non-small-cell lung cancer. We defined cN2α as only involvement of an upper mediastinal lymph node (UMLN) for a main tumour located in the upper lobe or as that of a lower mediastinal lymph node (LMLN) for a main tumour located in the lower lobe. cN2β was defined as involvement of an LMLN for a main tumour located in the upper lobe with or without metastatic UMLN or as that of a UMLN for a main tumour located in the lower lobe with or without metastatic LMLN. We analysed preoperative clinical factors, as well as overall and disease-free survival.
The overall 5-year survival rate was 30.6%, and the disease-free 5-year survival rate was 22.6%. The disease-free 5-year survival rate for a tumour located in an upper lobe was significantly better than that for a tumour located in a lower lobe (27.9 vs 11.1%, P = 0.007). A significant difference in survival was seen between cN2α and cN2β (29.6 vs 0%, P < 0.001), but not between cN2 single and multiple (23.4 vs 19.5%, P = 0.123). A multivariate analysis with Cox's proportional hazards model revealed that cN2α independently predicted good disease-free survival. The sensitivity, specificity and positive predictive value for pN2 single based on clinical CT findings were 72.7, 48.2 and 35.6%, respectively.
Clinical mediastinal lymph node status based on the location of the primary tumour and the node involved was an important preoperative prognostic factor. Thus, this factor should be considered when planning and evaluating clinical trials. Another important finding was that clinical single-station N2 is not always pathological single-station N2 disease.
N2 淋巴结受累站数被认为是肺癌最重要的预后因素之一。然而，大多数报告关注的是病理淋巴结状态而非临床淋巴结状态。我们研究了原发肿瘤位置与受累淋巴结之间的关系及其与预后的关联。
对1996年至2009年间接受手术切除的1257例原发性肺癌患者进行回顾性研究。其中，78例（6.2%）患有cN2、c期IIIA、pN2且为非小细胞肺癌。我们将cN2α定义为位于上叶的主肿瘤仅累及上纵隔淋巴结（UMLN），或位于下叶的主肿瘤仅累及下纵隔淋巴结（LMLN）。cN2β定义为位于上叶的主肿瘤累及LMLN且有或无UMLN转移，或位于下叶的主肿瘤累及UMLN且有或无LMLN转移。我们分析了术前临床因素以及总生存期和无病生存期。
5年总生存率为30.6%，5年无病生存率为22.6%。位于上叶的肿瘤5年无病生存率显著高于位于下叶的肿瘤（27.9%对11.1%，P = 0.007）。cN2α和cN2β之间的生存率存在显著差异（29.6%对0%，P < 0.001），但cN2单站和多站之间无显著差异（23.4%对19.5%，P = 0.123）。Cox比例风险模型的多因素分析显示，cN2α独立预测良好的无病生存期。基于临床CT表现对pN2单站的敏感性、特异性和阳性预测值分别为72.7%、48.2%和35.6%。
基于原发肿瘤位置和受累淋巴结的临床纵隔淋巴结状态是重要的术前预后因素。因此，在规划和评估临床试验时应考虑这一因素。另一个重要发现是临床单站N2并不总是病理单站N2疾病。
