Department of Thoracic Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
Thorac Cardiovasc Surg. 2021 Jun;69(4):366-372. doi: 10.1055/s-0040-1713613. Epub 2020 Jul 7.
This retrospective study investigated the prognosis of patients with pathological N1 (pN1) nonsmall cell lung cancer (NSCLC).
We included patients with pN1 NSCLC who underwent lobectomy or pneumonectomy with mediastinal lymph node dissection and achieved complete resection (R0) between January 2000 and December 2012. Patients who received neoadjuvant therapy were excluded.
A total of 249 patients were included. The mean age was 63.2 years, and 172 patients were males. Of the 249 patients, 200, 20, and 29 underwent lobectomy, bilobectomy, and pneumonectomy, respectively. The median observation period was 5.5 years. The 5-year overall survival (OS) rate was 64.6% (95% confidence interval: 58.3-70.4). Five-year OS rates were 79.8% for positive lymph nodes at station 13 or 14 ( = 57), 59.6% at station 12 ( = 72), 62.7% at station 11 ( = 69), and 56.9% at station 10 ( = 51) (log-rank test; = 0.016); furthermore, the 5-year OS rate was 75.2% for patients with positive lymph nodes at a single station ( = 160) and 45.4% for patients with positive lymph nodes at multiple stations ( = 89) (log-rank test; < 0.001). Five-year cumulative incidences of recurrence were equivalent between patients who received adjuvant chemotherapy and patients who did not (45.9 vs. 55.1%; Gray's test; = 0.366). Distant recurrence was the most frequent mode of recurrence in both groups (70.8 and 67.3%).
The locations and the number of stations of the positive lymph nodes were identified as prognostic factors in patients with pN1 NSCLC. The primary mode of recurrence was distant recurrence irrespective of postoperative adjuvant chemotherapy.
本回顾性研究调查了病理 N1（pN1）非小细胞肺癌（NSCLC）患者的预后。
我们纳入了 2000 年 1 月至 2012 年 12 月期间接受肺叶切除术或全肺切除术并伴有纵隔淋巴结清扫术且达到完全切除（R0）的 pN1 NSCLC 患者。排除接受新辅助治疗的患者。
共纳入 249 例患者。患者的平均年龄为 63.2 岁，男性 172 例。249 例患者中，200 例行肺叶切除术，20 例行双肺叶切除术，29 例行全肺切除术。中位观察期为 5.5 年。5 年总生存率（OS）为 64.6%（95%置信区间：58.3-70.4）。淋巴结站 13 或 14 阳性的 5 年 OS 率为 79.8%（=57），淋巴结站 12 阳性的 5 年 OS 率为 59.6%（=72），淋巴结站 11 阳性的 5 年 OS 率为 62.7%（=69），淋巴结站 10 阳性的 5 年 OS 率为 56.9%（=51）（对数秩检验；=0.016）；此外，淋巴结站阳性的 5 年 OS 率为 75.2%（=160），淋巴结站阳性的 5 年 OS 率为 45.4%（=89）（对数秩检验；<0.001）。接受辅助化疗的患者与未接受辅助化疗的患者的 5 年累积复发率相当（45.9%比 55.1%；Gray 检验；=0.366）。远处复发是两组患者最常见的复发模式（70.8%和 67.3%）。
pN1 NSCLC 患者的阳性淋巴结部位和数量被确定为预后因素。主要的复发模式是远处复发，与术后辅助化疗无关。
