The N2 paradox: similar outcomes of pre- and postoperatively identified single-zone N2a positive non-small-cell lung cancer

Tsitsias, Thomas; Boulemden, Anas; Ang, Keng Leong; Nakas, Apostolos; Waller, David

doi:10.1093/ejcts/ezt478

Cited by 27 publications

(22 citation statements)

References 20 publications

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“…These data, when contrasted with data from administrative databases in the United States, suggest that in Europe, surgical staging of the mediastinum, even with enlarged or FDG-avid N2 nodes, is performed less commonly and that primary operations for N2 disease occur more common. Support for upfront surgical treatment comes from the group from Leicester, United Kingdom, who suggest that intentional resection of preoperatively known singlestation N2 disease results in similar survival between patients with negative N1 and N2 PET-CT scans but are found to have unsuspected pN2 disease at the time of operation [12]. In that study, the need for pneumonectomy, noncompliance with adjuvant treatment, and multistation N2 nodal disease were adverse prognostic factors [12].…”

Section: N2 Seen From Different Anglesmentioning

confidence: 95%

“…Support for upfront surgical treatment comes from the group from Leicester, United Kingdom, who suggest that intentional resection of preoperatively known singlestation N2 disease results in similar survival between patients with negative N1 and N2 PET-CT scans but are found to have unsuspected pN2 disease at the time of operation [12]. In that study, the need for pneumonectomy, noncompliance with adjuvant treatment, and multistation N2 nodal disease were adverse prognostic factors [12]. The study was limited by its retrospective nature, small sample size (30 patients with cN2 disease/ 1,131 total patients [3%]) and failure to follow an established mediastinal surgical staging protocol like that suggested by the ESTS [1].…”

Section: N2 Seen From Different Anglesmentioning

confidence: 99%

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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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Section: N2 Seen From Different Anglesmentioning

confidence: 95%

Section: N2 Seen From Different Anglesmentioning

confidence: 99%

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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“…Forty patients had a clinical N2 diagnosis. The median postoperative hospital stay was 6 days (lower quartile and upper quartile, [5][6][7][8]. We recorded postoperative complications in 31 cases; 18 were classified as minor complications (Common Terminology for Adverse Events 4.03, Grades 1 and 2).…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, no changes were made to N descriptors, which have been based only on anatomical criteria since the TNM edition issued in 1982. Nevertheless, the IASLC staging committee [4] reproposed the introduction of new subgroups of N-positive components; similar proposals were promoted in the 7th edition of lung cancer TNM and in several retrospective series [5][6][7][8]. Nevertheless, no sufficiently significant data were available to support the introduction of these changes in the official edition of the TNM staging system.…”

Section: Discussionmentioning

confidence: 99%

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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“…Over the past decade, the morbidity and mortality of lung cancer have markedly increased in China (Yang et al, 2004). There are 2 main types of lung cancer: small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC); NSCLC accounts for approximately 85% of all cases of lung cancer and shows poor prognosis (Tsitsias et al, 2013). To improve the poor prognosis of patients with NSCLC, the biology of lung cancer, including the effects of chemokines, must be further understood.…”

Section: Introductionmentioning

confidence: 99%

Relationship between genetic polymorphisms in MCP-1, CCR-2, and non-small-cell lung cancer in the Han nationality of Northern China

Yang¹,

Wang²,

Li³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. Lung cancer is a common malignant tumor worldwide and is now the leading cause of cancer-related deaths. Monocyte chemoattractant protein 1 (MCP-1) and its receptor chemokine receptor 2 (CCR-2) are important chemokines. We examined the polymorphisms of 338 unrelated patients with non-small cell lung carcinoma (NSCLC) and 200 unrelated healthy controls of Han nationality in Northern China using polymerase chain reaction-restriction fragment length polymorphism. We found a significant increase in the frequency of the = 0.38-0.95) was lower in lung cancer patients than in healthy controls. Based on these results, the polymorphism in MCP-1 may be correlated with the development of NSCLC in the Han nationality of Northern China. However, the polymorphism in CCR-2 is not involved in NSCLC.

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The N2 paradox: similar outcomes of pre- and postoperatively identified single-zone N2a positive non-small-cell lung cancer

Abstract: Our results support a policy of intentionally resecting single-zone N2a NSCLC identified preoperatively as part of a multimodality therapy.

Cited by 27 publications

References 20 publications

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

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

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

Relationship between genetic polymorphisms in MCP-1, CCR-2, and non-small-cell lung cancer in the Han nationality of Northern China

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