The impact of residual multi-level N2 disease after induction therapy for non-small cell lung cancer

被引:39
作者
Sawabata, N
Keller, SM
Matsumura, A
Kawashima, O
Hirono, T
Osaka, Y
Maeda, H
Fukai, S
Kawahara, M
机构
[1] Toneyama Natl Hosp, Div Surg, Toyonaka, Osaka 5608552, Japan
[2] Montefiore Med Ctr, Dept Cardiothorac Surg, Bronx, NY 10467 USA
[3] Nishi Gunma Natl Hosp, Div Surg, Gunma, Japan
[4] Sapporo Minami Natl Hosp, Div Surg, Sapporo, Hokkaido, Japan
关键词
non-small cell lung cancer; induction therapy; surgery; mediastinal nodal status; survival; mediastinoscopy;
D O I
10.1016/S0169-5002(03)00245-9
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The presence of residual N2 disease following induction therapy for locally advanced non-small cell lung cancer (NSCLC) has been proposed as a contraindication to surgery. However, single level N2 metastases found in the operative specimens of patients with clinical NO NSCLC who did not receive induction therapy is associated with prolonged survival. In order to investigate whether residual single level N2 disease following induction therapy was similarly associated with prolonged survival, we conducted a retrospective review of patients with stages Ilia and IIIb NSCLC who had undergone induction therapy followed by surgery. Methods: A retrospective review was performed of the hospital records of patients with stages Ilia and Illb NSCLC who had undergone induction therapy consisting of chemotherapy and/or radiotherapy followed by tumor resection and mediastinal lymph node dissection at 11 Japanese national referral hospitals. Survival was analyzed by the Kaplan-Meier method and prognostic factors were determined by the log-rank and Cox regression methods. Results: One hundred thirty-one patients underwent induction therapy of NSCLC stages IIIa (n = 95) and IIIb (n = 36) followed by complete tumor resection during a 12-year interval. Clinical N2 disease was present in 114 (87%) patients and N3 disease in 17 (13%) patients. Median follow up was 48 months. Eighteen patients had residual. single level N2 disease and 25 patients had multiple residual N2 level. metastases. The 5-year survival was 54% for patients with pathologic single level N2 disease and 11% for patients with multiple N2 level. disease (P < 0.01). In a multivariate analysis, only the pathologic N status significantly influenced survival. Conclusion: Patents who have multiple levels of N2 disease have a much worse prognosis than patients who have single level. of N2. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:69 / 77
页数:9
相关论文
共 32 条
[1]   CONCURRENT CISPLATIN/ETOPOSIDE PLUS CHEST RADIOTHERAPY FOLLOWED BY SURGERY FOR STAGES IIIA(N2) AND IIIB NON-SMALL-CELL LUNG-CANCER - MATURE RESULTS OF SOUTHWEST-ONCOLOGY-GROUP PHASE-II STUDY-8805 [J].
ALBAIN, KS ;
RUSCH, VW ;
CROWLEY, JJ ;
RICE, TW ;
TURRISI, AT ;
WEICK, JK ;
LONCHYNA, VA ;
PRESANT, CA ;
MCKENNA, RJ ;
GANDARA, DR ;
FOSMIRE, H ;
TAYLOR, SA ;
STELZER, KJ ;
BEASLEY, KR ;
LIVINGSTON, RB .
JOURNAL OF CLINICAL ONCOLOGY, 1995, 13 (08) :1880-1892
[2]  
ALBERTI W, 1995, BRIT MED J, V311, P899
[3]   Survival of patients with resected N2 non-small-cell lung cancer: Evidence for a subclassification and implications [J].
Andre, F ;
Grunenwald, D ;
Pignon, JP ;
Dujon, A ;
Pujol, JL ;
Brichon, PY ;
Brouchet, L ;
Quoix, E ;
Westeel, V ;
Le Chevalier, T .
JOURNAL OF CLINICAL ONCOLOGY, 2000, 18 (16) :2981-2989
[4]   Nodal stage after induction therapy for stage IIIA lung cancer determines patient survival [J].
Bueno, R ;
Richards, WG ;
Swanson, SJ ;
Jaklitsch, MT ;
Lukanich, JM ;
Mentzer, SJ ;
Sugarbaker, DJ .
ANNALS OF THORACIC SURGERY, 2000, 70 (06) :1826-1831
[5]   Potential impact on survival of improved tumor downstaging and resection rate by preoperative twice-daily radiation and concurrent chemotherapy in stage IIIA non-small-cell lung cancer [J].
Choi, NC ;
Carey, RW ;
Daly, W ;
Mathisen, D ;
Wain, J ;
Wright, C ;
Lynch, T ;
Grossbard, M ;
Grillo, H .
JOURNAL OF CLINICAL ONCOLOGY, 1997, 15 (02) :712-722
[6]   Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and IIIa non-small-cell lung cancer [J].
Depierre, A ;
Milleron, B ;
Moro-Sibilot, D ;
Chevret, S ;
Quoix, E ;
Lebeau, B ;
Braun, D ;
Breton, JL ;
Lemarié, E ;
Gouva, S ;
Paillot, N ;
Bréchot, JM ;
Janicot, H ;
Lebas, FX ;
Terrioux, P ;
Clavier, J ;
Foucher, P ;
Monchâtre, M ;
Coëtmeur, D ;
Level, MC ;
Leclerc, P ;
Blanchon, F ;
Rodier, JM ;
Thiberville, L ;
Villeneuve, A ;
Westeel, V ;
Chastang, C .
JOURNAL OF CLINICAL ONCOLOGY, 2002, 20 (01) :247-253
[7]  
ELIAS AD, 1997, P AN M AM SOC CLIN, V16, P448
[8]   Role of transesophageal endosonography-guided fine-needle aspiration in the diagnosis of lung cancer [J].
Fritscher-Ravens, A ;
Soehendra, N ;
Schirrow, L ;
Sriram, PVJ ;
Meyer, A ;
Hauber, HP ;
Pforte, A .
CHEST, 2000, 117 (02) :339-345
[9]  
GINSBERG RJ, 1987, J THORAC CARDIOV SUR, V94, P673
[10]   Mediastinal lymphadenopathy: Diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance - Initial experience [J].
Goldberg, SN ;
Raptopoulos, V ;
Boiselle, PM ;
Edinburgh, KJ ;
Ernst, A .
RADIOLOGY, 2000, 216 (03) :764-767