Garelli Elena, Renaud Stéphane, Falcoz Pierre-Emmanuel, Weingertner Noëlle, Olland Anne, Santelmo Nicola, Massard Gilbert
Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France Research Unite EA3430: Tumoral Progression and Micro-environment, Translational and Epidemiological Approaches, Strasbourg University, Strasbourg, France
Eur J Cardiothorac Surg. 2016 Aug;50(2):322-8. doi: 10.1093/ejcts/ezw036. Epub 2016 Feb 25.
The management of pIIIA-N2 non-small-cell lung cancer (NSCLC) is still controversial. In particular, there are wide variations in overall survival (OS), suggesting the existence of subgroups among N2 patients. We aimed to evaluate the prognostic value of microscopic pN2 in NSCLC.
Between 1996 and 2015, the data from all 982 pathologically stage IIIA-N2 patients who underwent surgery with curative intent for NSCLC were retrospectively reviewed. Microscopic pN2 disease was defined as a nodal metastasis ranging from 0.2 to 2 mm in size.
With a median follow-up of 17 months (2-101), the 5-year OS for the whole cohort was 31%. Microscopic N2 was observed in 309 (31.5%) patients. Microscopic N2 was associated with better median OS compared with macroscopic N2 [42 months (95% CI 36.85-47.15) vs 23 months (95% CI 19.7-26.29), P < 0.0001, with a corresponding 5-year OS rate of 39 and 21%, respectively]. In multivariate analysis, microscopic N2 remained a favourable independent prognostic factor [HR 0.681 (95% CI 0.481-0.967), P = 0.03]. The median OS of microscopic N2 patients who benefitted from simple follow-up was significantly better than those who underwent chemotherapy, radiation therapy or both [43 months (95% CI 24.22-61.78) vs 22 months (95% CI 17.43-26.47) vs 31 months (95% CI 27.66-34.34) vs 16 months (95% CI 14.6-17.4), P = 0.008].
Microscopic N2 seems to be associated with better prognosis in patients with pIIIA-N2 NSCLC and these could benefit from a simple follow-up. Prospective cohort studies are necessary to confirm these preliminary results.
IIIA-N2期非小细胞肺癌（NSCLC）的治疗仍存在争议。特别是，总生存期（OS）差异很大，提示N2患者中存在亚组。我们旨在评估NSCLC中微观pN2的预后价值。
回顾性分析1996年至2015年间所有982例接受了根治性手术的IIIA-N2期NSCLC患者的数据。微观pN2疾病定义为大小在0.2至2mm之间的淋巴结转移。
中位随访时间为17个月（2-101个月），整个队列的5年总生存率为31%。309例（31.5%）患者观察到微观N2。与宏观N2相比，微观N2的中位总生存期更好[42个月（95%CI 36.85-47.15）vs 23个月（95%CI 19.7-26.29），P<0.0001，相应的5年总生存率分别为39%和21%]。多因素分析中，微观N2仍然是一个有利的独立预后因素[HR 0.681（95%CI 0.481-0.967），P=0.03]。单纯接受随访的微观N2患者的中位总生存期明显优于接受化疗、放疗或两者的患者[43个月（95%CI 24.22-61.78）vs 22个月（95%CI 17.43-26.47）vs 31个月（95%CI 27.66-34.34）vs 16个月（95%CI 14.6-17.4），P=0.008]。
微观N2似乎与IIIA-N2期NSCLC患者更好的预后相关，这些患者可能从单纯随访中获益。需要前瞻性队列研究来证实这些初步结果。
