Maniwa Tomohiro, Takahashi Shoji, Isaka Mitsuhiro, Endo Masahiro, Ohde Yasuhisa
Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan.
Surg Today. 2016 Jun;46(6):699-704. doi: 10.1007/s00595-015-1268-2. Epub 2015 Nov 2.
The role of surgery for patients with non-small cell lung cancer (NSCLC) with clinical mediastinal lymph node metastasis (N2) remains controversial. We specified 4 criteria for performing initial surgery in these patients (single-station N2, non-bulky N2, N2 with regional mode of spread, and N2 without N1) and examined the outcomes to validate the treatment options.
Between September 2002 and December 2010, of 1290 patients who underwent complete resection for NSCLC, 808 patients underwent initial standard resection, including 779 patients with cN0-1 and 29 with cN2. We compared the outcomes, and evaluated patients with cN2-pN2.
The median follow-up was 45.5 months (3-119 months). Seventy (9.0 %) and 24 (82.8 %) patients had p-N2 in the cN0-1 and cN2 groups, respectively (p < 0.0001). The 5-year disease-free survival (DFS) rates in the cN0-1 and cN2 groups were 73.3 and 50.6 %, respectively (p = 0.0053), and the 5-year overall survival (OS) rates were 81.3 and 71.1 %, respectively (p = 0.051). The 5-year DFS and OS of patients with cN2-pN2 were 52.5 and 72.6 %, respectively.
Patients with clinical N2 disease based on our criteria represent a highly specific group with a favorable prognosis. Resection should therefore be the initial treatment for these patients.
手术治疗临床存在纵隔淋巴结转移（N2）的非小细胞肺癌（NSCLC）患者的作用仍存在争议。我们制定了在这些患者中进行初次手术的4条标准（单站N2、非巨大N2、具有区域扩散模式的N2以及无N1的N2），并检查结果以验证治疗方案。
在2002年9月至2010年12月期间，1290例行NSCLC根治性切除术的患者中，808例接受了初次标准切除术，其中包括779例cN0 - 1患者和29例cN2患者。我们比较了结果，并对cN2 - pN2患者进行了评估。
中位随访时间为45.5个月（3 - 119个月）。cN0 - 1组和cN2组分别有70例（9.0%）和24例（82.8%）患者出现p - N2（p < 0.0001）。cN0 - 1组和cN2组的5年无病生存率（DFS）分别为73.3%和50.6%（p = 0.0053），5年总生存率（OS）分别为81.3%和71.1%（p = 0.051）。cN2 - pN2患者的5年DFS和OS分别为52.5%和72.6%。
基于我们标准的临床N2期疾病患者是一个预后良好的高度特定群体。因此，手术应作为这些患者的初始治疗方法。
