Effectiveness of Radical Systematic Mediastinal Lymphadenectomy in Patients With Resectable Non-Small Cell Lung Cancer

Yang

2011

Chin. J. Cancer Res.

Objective: To identify clinical and pathologic factors that were associated with the survival of stage IB upper lobe non-small cell lung cancer (NSCLC) patients.Methods: A retrospective study of 147 subjects who had undergone curative resection for stage IB upper lobe NSCLC was performed. Patients who had received any adjuvant or neo-adjuvant chemotherapy were excluded. Survival function curves were estimated using the Kaplan-Meier procedure. Crude and adjusted hazard ratios (HRs) of potential prognostic factors were estimated using Cox proportional hazards models.Results: Five factors, including age, tumor size, histologic grade of differentiation, number of removed superior mediastinal lymph node stations and presence of visceral pleura invasion, were significantly and independently associated with mortality risk. Adjusted HRs were 2.6 [95% confidence interval (95% CI): 1.1−6.5] and 4.6 (95% CI: 1.9−11) for those aged 58−68 years and those >68 years, respectively, relative to those aged <58 years. HRs for those with poorly and moderately differentiated tumors were 6.4 (95% CI: 2.3−18) and 1.4 (95% CI: 0.7−2.8), respectively. HRs for those with tumor size 3.1−5 cm and >5 cm (vs ≤3.0 cm) were 2.3 (95% CI: 1.1−4.9) and 4.3 (95% CI: 1.9−10), respectively. The presence of visceral pleura invasion also increased the risk of mortality (HR=4.0, 95% CI: 1.3−12).Conclusion: Advanced age, larger tumor size, poorly differentiated histology, smaller number of removed superior mediastinal lymph node stations, and presence of visceral pleura invasion were associated with poor survival of surgically treated stage IB upper lobe NSCLC patients.

Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival of stage IB upper lobe non-small cell lung cancer patients: A retrospective study in Shanghai, China

Yang

2011

Chin. J. Cancer Res.

“…However, there have been a limited number of randomized prospective trials that had compared SND with LS in patients with NSCLC (4,5,19). Izbicki (4) and Wu (5) investigated patients with a wide range of clinical stages which included clinical stage I to IIIA, while Sugi (19) investigated a rather limited population which included patients with peripheral lung cancer smaller than 2 cm in diameter.…”

Section: Discussionmentioning

confidence: 99%

“…With the examination of the stage migration, survival according to the pathological stage, which may be affected by spurious downstaging caused by inadequate staging, should be reviewed. Izbicki (4) described that insufficiency in staging accuracy of LS might have affected poorer outcome of small group of patients with limited lymph node involvement (pN1 disease or single-level pN2 disease). In our study, there was no significant difference in pN0 cases between the SND group and the LS group.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer

et al. 2008

:Objective : Systematic nodal dissection has been recommended for patients with resectable non-small cell lung cancer because of its staging accuracy. However, in patients with clinical stage I non-small cell lung cancer whether systematic nodal dissection provides more benefits than mediastinal lymph node sampling or not is controversial. In this retrospective study, we evaluated the effect of mediastinal lymph node sampling in patients with clinical stage I NSCLC. Methods : One hundred and nineteen consecutive patients with clinical stage I NSCLC, who underwent curative operation between January 1994 and December 2000, were retrospectively reviewed (dissection group = 58 : sampling group= 61). Systematic nodal dissection was defined as complete removal of mediastinal lymph node, and mediastinal lymph node sampling was defined as removal of lymph node levels 3, 4, and 7 for right-sided tumors and levels 5, 6, and 7 for left-sided tumors. Results : The total number of removed mediastinal lymph nodes in patients who underwent systematic nodal dissection was 22.1 9.7, which was significantly higher than that in patients who underwent mediastinal lymph node sampling of 11.4 7.0 (p 0.001). Postoperatively N2 disease was detected in 8 patients (13.8% %) in the dissection group and 7 (11.5% %) in the sampling group. After the median follow up of 79 months, the cancer specific survival rate at 5 year was 78.0% % in the dissection group and 76.2% % in the sampling group (p = 0.60). Conclusions : Mediastinal lymph node sampling showed the similar effect to systematic nodal dissection in patients with clinical stage I non-small cell lung cancer. J. Med. Invest. 55 : 37-43, February, 2008

“…[7][8][9][10][11][12] There are still many questions left unanswered regarding selection of surgical candidates and whether adjuvant CT and/ or RT should be provided before or after surgery, as well as the optimal drugs, dose, order, and number of adjuvant treatment modalities. 13 After surgical resection, Okada et al found that 48.9% of patients with T3N0 disease and 21.1% of patients with N2 disease survived 5 years.…”

Section: Resectable Diseasementioning

confidence: 99%

Five‐year lung cancer survival

Wang¹,

Nelson²,

Bogardus³

et al. 2010

Cancer

138

BACKGROUND:The core strategy of American College of Chest Physicians lung cancer guidelines is identification of the earliest symptoms of lung cancer and the immediate initiation of diagnosis and treatment. In the absence of screening, most symptomatic lung cancer is discovered at advanced stages, with the goal of long‐term survival entirely dependent on effective treatment of stage III and IV lung cancer.METHODS:In a retrospective review, all patients diagnosed with stage IIIA, IIIB, and IV nonsmall cell lung cancer (NSCLC) between the years 1986 and 2001 at City of Hope National Medical Center who survived 5 years or longer were analyzed to identify parameters that might predict long‐term survival.RESULTS:Of 846 patients presenting with stage III or IV disease, 56 (6.6%) survived 5 years or longer. Sixteen patients died of primary tumor progression beyond 5 years. Two 5‐year survivors died of second tobacco‐caused neoplasms, and 16 died from medical conditions potentially related to prior treatment. A substantial majority of survivors were from specific pathologic subsets including: 1) resectable N2 disease (n = 17, 30.4%), 2) multiple lung tumors (n = 7, 12.5%), 3) T3N0 (n = 5, 8.1%), and 4) single site distant metastasis (n = 8, 14.2%).CONCLUSIONS:Despite aggressive multimodality therapy, 5‐year survival in patients with advanced stage NSCLC was very poor and limited to small pathological subsets. Patients with advanced stage NSCLC who did not belong to 1 of these subsets had a small chance of long‐term survival. Cancer 2010. © 2010 American Cancer Society.