Surgical Results in Pathological N1 Nonsmall Cell Lung CancerFunding This study was not funded by any external source.
29 December 2019
17 April 2020
07 July 2020 (online)
Background This retrospective study investigated the prognosis of patients with pathological N1 (pN1) nonsmall cell lung cancer (NSCLC).
Methods 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.
Results 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 (n = 57), 59.6% at station 12 (n = 72), 62.7% at station 11 (n = 69), and 56.9% at station 10 (n = 51) (log-rank test; p = 0.016); furthermore, the 5-year OS rate was 75.2% for patients with positive lymph nodes at a single station (n = 160) and 45.4% for patients with positive lymph nodes at multiple stations (n = 89) (log-rank test; p < 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; p = 0.366). Distant recurrence was the most frequent mode of recurrence in both groups (70.8 and 67.3%).
Conclusion 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.
This study was presented at the 36th Annual Meeting of the Japanese Association for Chest Surgery in Osaka, Japan, May 16-17, 2019.
- 1 Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143 (5, Suppl): e278S-e313S
- 2 Rusch VW, Crowley J, Giroux DJ. , et al; International Staging Committee; Cancer Research and Biostatistics; Observers to the Committee; Participating Institutions. The IASLC lung cancer staging project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 2007; 2 (07) 603-612
- 3 Okami J, Shintani Y, Okumura M. , et al; Japanese Joint Committee of Lung Cancer Registry. Demographics, safety and quality, and prognostic information in both the seventh and Eighth Editions of the TNM Classification in 18,973 surgical cases of the Japanese Joint Committee of Lung Cancer Registry Database in 2010. J Thorac Oncol 2019; 14 (02) 212-222
- 4 Maeshima AM, Tsuta K, Asamura H, Tsuda H. Prognostic implication of metastasis limited to segmental (level 13) and/or subsegmental (level 14) lymph nodes in patients with surgically resected nonsmall cell lung carcinoma and pathologic N1 lymph node status. Cancer 2012; 118 (18) 4512-4518
- 5 Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours. 7th ed. Oxford: Wiley; 2009
- 6 Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC. , eds. Pathology and Genetics: Tumours of the Lung, Pluera, Thymus and Heart. Lyon: IARC Press; 2004
- 7 Donington J, Ferguson M, Mazzone P. , et al; Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons. American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest 2012; 142 (06) 1620-1635
- 8 Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 1988; 16: 1141-1154
- 9 Mordant P, Pricopi C, Legras A. , et al. Prognostic factors after surgical resection of N1 non-small cell lung cancer. Eur J Surg Oncol 2015; 41 (05) 696-701
- 10 Rena O, Boldorini R, Papalia E. , et al. Metastasis to subsegmental and segmental lymph nodes in patients resected for non-small cell lung cancer: prognostic impact. Ann Thorac Surg 2014; 97 (03) 987-992
- 11 Liu CY, Hung JJ, Wang BY, Hsu WH, Wu YC. Prognostic factors in resected pathological N1-stage II nonsmall cell lung cancer. Eur Respir J 2013; 41 (03) 649-655
- 12 Demir A, Turna A, Kocaturk C. , et al. Prognostic significance of surgical-pathologic N1 lymph node involvement in non-small cell lung cancer. Ann Thorac Surg 2009; 87 (04) 1014-1022
- 13 Sayar A, Turna A, Kiliçgün A, Solak O, Urer N, Gürses A. Prognostic significance of surgical-pathologic multiple-station N1 disease in non-small cell carcinoma of the lung. Eur J Cardiothorac Surg 2004; 25 (03) 434-438
- 14 Marra A, Hillejan L, Zaboura G, Fujimoto T, Greschuchna D, Stamatis G. Pathologic N1 non-small cell lung cancer: correlation between pattern of lymphatic spread and prognosis. J Thorac Cardiovasc Surg 2003; 125 (03) 543-553
- 15 Aydogmus U, Cansever L, Sonmezoglu Y, Karapinar K, Kocaturk CI, Bedirhan MA. The impact of the type of resection on survival in patients with N1 non-small-cell lung cancers. Eur J Cardiothorac Surg 2010; 37 (02) 446-450
- 16 Fujimoto T, Cassivi SD, Yang P. , et al. Completely resected N1 non-small cell lung cancer: factors affecting recurrence and long-term survival. J Thorac Cardiovasc Surg 2006; 132 (03) 499-506
- 17 Shin S, Kim HK, Choi YS, Kim K, Kim J, Shim YM. Prognosis of unexpected and expected pathologic N1 non-small cell lung cancer. Ann Thorac Surg 2013; 96 (03) 969-975 , discussion 975–976
- 18 Watanabe S, Asamura H, Suzuki K, Tsuchiya R. Problems in diagnosis and surgical management of clinical N1 non-small cell lung cancer. Ann Thorac Surg 2005; 79 (05) 1682-1685
- 19 Kim MP, Correa AM, Hofstetter W. , et al. Limitations of 18F-2-deoxy-D-glucose positron emission tomography in N1 detection in patients with pathologic stage II-N1 and implications for management. Ann Thorac Surg 2015; 99 (02) 414-420
- 20 Decaluwé H, Stanzi A, Dooms C. , et al; Leuven Lung Cancer Group. Central tumour location should be considered when comparing N1 upstaging between thoracoscopic and open surgery for clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2016; 50 (01) 110-117
- 21 Decaluwé H, Petersen RH, Brunelli A. , et al; MITIG-ESTS. Multicentric evaluation of the impact of central tumour location when comparing rates of N1 upstaging in patients undergoing video-assisted and open surgery for clinical Stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2018; 53 (02) 359-365
- 22 Yasufuku K, Nakajima T, Waddell T, Keshavjee S, Yoshino I. Endobronchial ultrasound-guided transbronchial needle aspiration for differentiating N0 versus N1 lung cancer. Ann Thorac Surg 2013; 96 (05) 1756-1760
- 23 Pisters KM, Le Chevalier T. Adjuvant chemotherapy in completely resected non-small-cell lung cancer. J Clin Oncol 2005; 23 (14) 3270-3278
- 24 Pignon JP, Tribodet H, Scagliotti GV. , et al; LACE Collaborative Group. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 2008; 26 (21) 3552-3559
- 25 Park BJ, Cho JH, Lee JH. , et al. Temporal and regional distribution of initial recurrence site in completely resected N1-stage II lung adenocarcinoma: the effect of postoperative adjuvant chemotherapy. Lung Cancer 2018; 117: 7-13