Patients with stadium III (pN2) non-small cell lung cancer form a heterogeneous group with broad differences in survival. Some selected patients seem to benefit from surgery, but in most patients other therapies are preffered. The present study was performed to select groups of patients who will and will not benefit from surgery.
A total of 242 patients with stadium III (pN2) who all underwent mediastinoscopy and tumor resection between 1977 and 1995 were retrospectively reviewed. Mean age was 64.2 years. Mediastinoscopy showed malignancy in 56 patients (23.1%). Resection was complete in 198 patients. Most patients (n=150) had one mediastinal lymph node station involved and T2 was the most frequently found T-status. Hundred and sixty-six patients received adjuvant therapy, mainly radiotherapy.Statistical analyses were performed, using the Kaplan-Meier method, the log rank test and Cox’s proportional hazards model.
The cumulative post-operative survival at 5 years was 20.3%. The number of mediastinal stations involved (≤ 2; p=0.03)(Fig.1.) and age (≤ 60 years; p=0.035) significantly influenced survival whereas T-status (T1/T2 versus T3/T4; p=0.056) approached significance. No differences in survival between patients with a positive versus negative mediastinoscopy, or between patients with a complete versus incomplete resection were found. However, all patients with a positive mediastinoscopy and incomplete resection died within 3 years. Multivariate analysis showed the number of mediastinal lymph node stations involved (RR of 0.33, 95% CI of 0.163 to 0.663; p=0.002) and age (RR of 1.013, 95% CI of 1.0 to 1.027; p=0.048) to be prognostic for survival.
Stadium III (pN2) patients with ≤ 2 mediastinal stations involved (even detected at mediastinoscopy) and those aged ≤ 60 years can benefit from surgery. Patients with ’bulky’or fixed multistation disease and those with a T3 or T4 tumor should not be operated upon.
Accurate staging of pN2 patients may prevent them from an advanced (incomplete) resection with high morbidity and even mortality, but on the other hand, can sort out the patients who will benefit from surgery.
Edwin Van Velzen, None.