Long-Term Survival of Patients With pN2 Lung Cancer According to the Pattern of Lymphatic Spread

Legras, Antoine; Mordant, Pierre; Arame, Alex; Foucault, Christophe; Dujon, Antoine; Pimpec-Barthes, Françoise Le; Riquet, Marc

doi:10.1016/j.athoracsur.2013.12.047

Cited by 57 publications

(40 citation statements)

References 26 publications

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“…Asamura et al [4] found significant differences in terms of OS and DFI between the 3 groups they proposed, with a worse longterm survival for patients with multiple mediastinal station involvement and a significantly better prognosis for patients with skip metastasis and limited involvement of mediastinal lymph nodes; similar results were also reported by other authors [9][10][11]. An anatomical explanation for this phenomenon lies in the possible direct lymphatic drainage into the mediastinal nodes, completely bypassing the intralobar and hilar stations, but other explanations have been proposed [12].…”

Section: Discussionsupporting

confidence: 77%

“…Surprisingly, our median 3-and 5-year survival rates for patients diagnosed as N2a1 were considerably better than those reported for N2 patients treated with neoadjuvant therapy and surgery [14,16]. Similarly, a recent French report [11] on 871 patients advocated for a better stratification of IIIA-N2 NSCLC, because they found a significant difference in OS according to the number and position of the lymph node stations involved.…”

Section: Discussioncontrasting

confidence: 49%

“…Thirty-three were T1 and 60 were T2. We resected a median number of 6 lymph node stations (lower quartile and upper quartile, 4-8) and 15 nodes per patient (lower quartile and upper quartile, [11][12][13][14][15][16][17][18][19][20]; in detail, 6 (lower quartile and upper quartile 4-7) were hilar nodes and 9 (lower quartile and upper quartile 6-14) were mediastinal nodes.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

N2 lung cancer is not all the same: an analysis of different prognostic groups†

Bertoglio

Ricciardi

Alì

et al. 2018

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES:The International Association for the Study of Lung Cancer (IASLC) recently proposed a change in the staging system for N2, based on the metastatic station number: N2a1 (a single metastatic station with no hilar involvement), N2a2 (a single metastatic station with hilar involvement) and N2b (multiple metastatic stations). The aim of our study was to validate the IASLC proposal in a cohort of patients with pathological N2 disease. METHODS:All patients with pathological T1-T2 N2 non-small-cell lung cancer who were operated on between 2006 and 2010 in our department were enrolled. The patients had lobectomy, bilobectomy or pneumonectomy without induction therapy; patients with any type of extended resection were excluded. All patients had adjuvant treatment. The impact of the new IASLC proposal on the overall and disease-free survival rates was then analysed. RESULTS:Ninety-three patients were selected. The median follow-up period and overall survival time were 92 and 28.8 months, respectively. According to the new IASLC proposal, we observed 22 cases of N2a1, 54 N2a2 and 17 N2b. Patients with N2a1 had a significantly better overall survival than those with N2a2 and N2b (P = 0.041); the difference between N2a2 and N2b was not significant (P = 0.19). Patients with N2a1 squamous cell carcinoma had a significantly better overall survival than those with other histological diagnoses (P = 0.046). The disease-free interval was longer in patients with N2a1 than those in other groups (P = 0.021).CONCLUSIONS: Our experience partially validates the IASLC proposal; the introduction of quantitative criteria for N staging might improve stratification of patients and the assignment to the correct therapeutic path.

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Section: Discussionsupporting

confidence: 77%

Section: Discussioncontrasting

confidence: 49%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

N2 lung cancer is not all the same: an analysis of different prognostic groups†

Bertoglio

Ricciardi

Alì

et al. 2018

Interactive CardioVascular and Thoracic Surgery

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“…Importantly, the 3-year and 5-year survivals for these patients with unsuspected N2 disease were 80% and 40%, respectively [6]. Legras and colleagues [7], from France, emphasized the importance of coexisting N1 disease or disease with multiple-station nodal involvement as independent prognosticators in patients with N2 disease. In a retrospective analysis of 871 patients with pN2 disease who underwent resection during a 20-year period, the 5-year overall survival was 25% for patients with pN2 disease; however, for patients with "pure" single-station pN2 disease (ie, no N1 or other N2 station disease), survival increased to 34% (hazard ratio [HR]¼1.64) [7].…”

Section: Single-station Vs Multiple-station N2 Diseasementioning

confidence: 97%

Management of Stage IIIA (N2) Non-Small Cell Lung Cancer: A Transatlantic Perspective

Rocco

Nason

Brunelli

et al. 2016

The Annals of Thoracic Surgery

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“…Despite several revisions of the TNM lung cancer staging system, the N2 descriptor still brings together in one single category, a very different group of patients with dissimilar overall prognosis, ranging from microscopical/small single station N2 to multiple/bulky disease (1,2). At one end of this spectrum, the disease appears to be resectable, whilst, at the other end, it is obviously unresectable.…”

mentioning

confidence: 99%