Prognosis of multi‐level N2‐positive non‐small cell lung cancer according to lymph node staging using endobronchial ultrasound‐transbronchial biopsy

Abstract

BackgroundThe optimal treatment for stage IIIA‐N2 non‐small cell lung cancer (NSCLC) remains controversial, and multidisciplinary team approaches are needed. Downstaging after induction therapy is a good prognostic factor in surgical patients; however, re‐evaluation of nodal status before surgery is challenging. The aim of this study was to evaluate the prognosis of patients with multi‐level N2 NSCLC who received surgery or chemoradiation therapy (CRT) according to restaging using endobronchial ultrasound‐transbronchial aspiration (EBUS‐TBNA).MethodsThis was a single center, prospective study that included 16 patients with biopsy‐proven multi‐level N2 disease on initial EBUS‐TBNA that was restaged using EBUS‐TBNA after induction therapy. Cases downstaged after rebiopsy were treated surgically. Three‐year progression‐free survival (PFS) and locoregional PFS were determined using Kaplan–Meier analysis.ResultsOf the 16 patients (median age 58 years, male 63%), eight had persistent N2 disease and eight showed N2 clearance on restaging using EBUS‐TBNA. Ten patients underwent surgery, including two patients without N2 clearance. Recurrence and locoregional recurrence occurred in eight and five patients, respectively. The three‐year PFS was longer in patients with N2 clearance than in those with N2 persistent disease (57.1% vs. 37.5%). Patients with N2 clearance also had longer three‐year locoregional PFS than those with N2 persistent disease (71.4% vs. 62.5%).ConclusionsEBUS‐TBNA could be an effective diagnostic method for restaging in multi‐level N2 NSCLC patients after induction CRT. As this was a pilot study, further large‐scale randomized studies are needed.

Report of the Korean Association of Lung Cancer Registry (KALC-R), 2014

“…Additionally, the frequent use of positron emission tomography with computed tomography (PET-CT) has resulted in increased proportions of patients with stage IV lung cancer. Moreover, the use of PET-CT has made evaluation and characterization of the mediastinal lymph node more feasible; the endobronchial ultrasound-guided transbronchial needle aspiration has gained popularity and is an important diagnostic tool, especially in clinically evident N2 NSCLC [19].…”

Micropapillary Pattern of Stage IIIA-N 2 Lung Adenocarcinoma is a Prognostic Factor After Adjuvant Chemoradiotherapy

“…Previous studies have explored the prognostic factors of stage pIIIA N 2 NSCLC, including primary tumor size [30], lymph node ratio [31], number of lymph node stations [32] and mediastinal lymph node size [33]. In this study, tumor size was an independent prognostic factor.…”

Endosonography with lymph node sampling for restaging the mediastinum in lung cancer: A systematic review and pooled data analysis

“…22 All included patients were diagnosed pathologically in the initial staging. Five studies included stage IIIA-N2 patients [23][24][25][26][27] and 5 studies included stage IIIA/B(N2/N3) patients. 16,[28][29][30][31] The induction treatments of included studies contained chemotherapy and chemoradiation.…”

“…The patients who had stable disease or partial response after induction treatment were defined by radiologists through CT or PET/CT. Five studies [25][26][27]29,31 performed EBUS-TBNA alone, and 4 studies 23,24,28,30 performed EUS-FNA alone. One study used a combined approach to assess mediastinal lymph node metastases.…”