Hui Wing Kea, Charaf Zohra, Hendriks Jeroen M H, Van Schil Paul E
Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium.
Department of Cardiothoracic Surgery, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium.
Cancers (Basel). 2023 Jul 3;15(13):3475. doi: 10.3390/cancers15133475.
Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67-9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31-58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored.
传统上认为，患有意外N2（uN2）疾病的患者预后不佳。随着术前和术中纵隔分期技术的不断进步，uN2疾病的患病率也发生了变化。在本综述中，将对关于uN2疾病及其患病率的现有证据进行评估。我们进行了一项系统的文献检索，以识别所有纳入uN2疾病的研究或已完成并发表的试验，检索截至2023年4月6日，无语言限制。采用纽卡斯尔-渥太华量表（NOS）对纳入的论文进行评分。最初共识别出512篇文章，其中共有22项研究符合预定义的纳入标准。尽管进行了充分的纵隔分期，但真正意外的pN2（9387例患者）的合并患病率为7.97%（95%CI 6.67-9.27%），5年后的合并总生存率（892例患者）为44%（95%CI 31-58%）。uN2疾病特征方面的显著异质性极大地限制了我们的荟萃分析。然而，如果能够实现完全手术切除，uN2疾病患者似乎代表了一个预后与IIb期相似的亚组，辅助治疗的作用有待进一步探索。
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