Park Jae Kil, Moon Youngkyu
Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2019 Apr;11(4):1202-1212. doi: 10.21037/jtd.2019.04.30.
Nodal upstaging occasionally occurs after curative resection in clinical N0 non-small cell lung cancer (NSCLC). The purpose of this study was to evaluate the prognosis of clinical N0 NSCLC (T1-2, tumor size 5 cm or smaller) after upstaging to pathologic N1 or N2.
From 2005 to 2015, 676 consecutive patients were diagnosed with clinical T1-2N0 NSCLC and underwent curative resection. Among these, tumors were upstaged to N1 in 46 patients and to N2 in 24 patients. We analyzed the prognosis of upstaged tumors. For comparison of prognosis between nodal upstaging groups and others in the same stage, patients with preoperative pathologically proven N1 (n=31) and N2 (n=55) NSCLC were included in the study.
A total of 70 patients (10.4%) had nodal upstaging after curative resection of clinical N0 NSCLC. Upstaging to N1 occurred in 46 patients and upstaging to N2 occurred in 24 patients. The 5-year disease-specific survival rate was not statistically different between the upstaged and non-upstaged N1/N2 groups in N1 disease (73.3% 70.5%, P=0.247) or in N2 disease (58.9% 50.7%, P=0.283). Multivariate analysis showed that nodal upstaging was not a significant prognostic factor in N1 or N2 NSCLC (hazard ratio =0.385, P=0.235; hazard ratio =0.677, P=0.458).
Postoperative nodal upstaging from clinical T1-2N0 NSCLC was not a significant prognostic factor in the same stage. Therefore, surgical treatment of clinical T1-2N0 lung cancer diagnosed by imaging without preoperative pathologic lymph node staging can be a treatment option.
在临床N0非小细胞肺癌（NSCLC）的根治性切除术后，偶尔会出现淋巴结分期上调的情况。本研究的目的是评估临床N0 NSCLC（T1-2，肿瘤大小5厘米或更小）上调至病理N1或N2后的预后。
2005年至2015年，连续676例患者被诊断为临床T1-2N0 NSCLC并接受了根治性切除术。其中，46例患者的肿瘤上调至N1期，24例患者的肿瘤上调至N2期。我们分析了上调分期肿瘤的预后。为了比较淋巴结上调分期组与同一分期其他组之间的预后，术前经病理证实为N1（n = 31）和N2（n = 55）NSCLC的患者被纳入研究。
临床N0 NSCLC根治性切除术后，共有70例患者（10.4%）出现淋巴结分期上调。46例患者上调至N1期，24例患者上调至N2期。在N1期疾病中，上调分期组与未上调分期的N1/N2组之间的5年疾病特异性生存率无统计学差异（73.3%对70.5%，P = 0.247）；在N2期疾病中，两者之间的5年疾病特异性生存率也无统计学差异（58.9%对50.7%，P = 0.283）。多因素分析显示，淋巴结分期上调在N1或N2 NSCLC中不是一个显著的预后因素（风险比 = 0.385，P = 0.235；风险比 = 0.677，P = 0.458）。
临床T1-2N0 NSCLC术后的淋巴结分期上调在同一分期中不是一个显著的预后因素。因此，对于通过影像学诊断且未进行术前病理淋巴结分期的临床T1-2N0肺癌，手术治疗可以作为一种治疗选择。
