Mizuno Tetsuya, Arimura Takaaki, Kuroda Hiroaki, Sakakura Noriaki, Yatabe Yasushi, Sakao Yukinori
Division of Thoracic Surgery, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, 464-8681, Japan.
Division of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
Gen Thorac Cardiovasc Surg. 2017 Sep;65(9):519-526. doi: 10.1007/s11748-017-0799-4. Epub 2017 Jun 28.
Non-small cell lung cancer (NSCLC) patients at cN1 have unfavorable outcomes. It has been reported that a substantial proportion of cN1 patients have occult mediastinal disease, and treatment guidelines suggest invasive preoperative mediastinal evaluation. However, the population that would most benefit from invasive staging has not been defined. The aims of this study are to identify factors predicting mediastinal metastasis and outcomes in cN1 NSCLC patients to select appropriate candidates for invasive mediastinal evaluation.
We retrospectively studied 164 patients with radiologically diagnosed cN1 NSCLC. Clinicopathological factors including radiological nodal findings were reviewed. Factors predicting the pN2 status, disease-free survival (DFS), and overall survival (OS) were investigated.
Among 164 patients with cN1 disease, pN2 was diagnosed in 43 (26.4%). This pN2 subgroup included a higher proportion of cases with adenocarcinoma (AD) histology than the pN0/1 subgroup (60.5 vs. 38.8%, p = 0.012). Logistic regression analyses revealed AD as an independent predictor of the pN2 status, while radiological nodal findings were unrelated. Cox regression analyses identified lower preoperative serum CEA, non-AD, and pN0/1 status as favorable factors of DFS and adjuvant therapy to be associated with OS. Five-year DFS was much lower in the pN2 subgroup than the pN0/1 subgroup of AD patients (p < 0.001), while DFS was independent of pN status in non-AD patients.
Adenocarcinoma is predictive of pN2 and poor prognosis in radiologically diagnosed cN1 NSCLC. Accurate mediastinal staging may be more beneficial for prognoses and optimal treatment planning in NSCLC patients with AD histology.
cN1期非小细胞肺癌（NSCLC）患者预后不佳。据报道，相当一部分cN1期患者存在隐匿性纵隔疾病，治疗指南建议进行侵入性术前纵隔评估。然而，最能从侵入性分期中获益的人群尚未明确。本研究的目的是确定预测cN1期NSCLC患者纵隔转移和预后的因素，以选择适合进行侵入性纵隔评估的患者。
我们回顾性研究了164例经影像学诊断为cN1期NSCLC的患者。对包括影像学淋巴结表现在内的临床病理因素进行了回顾。研究了预测pN2状态、无病生存期（DFS）和总生存期（OS）的因素。
在164例cN1期疾病患者中，43例（26.4%）被诊断为pN2。与pN0/1亚组相比，该pN2亚组中腺癌（AD）组织学类型的病例比例更高（60.5%对38.8%，p = 0.012）。逻辑回归分析显示AD是pN2状态的独立预测因素，而影像学淋巴结表现与之无关。Cox回归分析确定术前血清CEA水平较低、非AD以及pN0/1状态是DFS的有利因素，辅助治疗与OS相关。AD患者的pN2亚组5年DFS远低于pN0/1亚组（p < 0.001），而非AD患者的DFS与pN状态无关。
腺癌可预测经影像学诊断的cN1期NSCLC患者的pN2和不良预后。准确的纵隔分期可能对具有AD组织学类型的NSCLC患者的预后和最佳治疗方案规划更有益。
