Surgical resection remains the primary modality for the potentially curative treatment of anatomically resectable non small cell lung cancer. The presence of mediastinal lymph node metastasis (N2 disease) is known for its association with a poor prognosis. The value and desirability of surgical resection for N2 disease remains controversial. The purpose of the study is to estimate the actuarial survival following surgical resection for N2 disease and determine the prognostic factors which influence survival.
Between 1994 and 2003, 51 patients underwent lung resection for pathologically proven N2 disease. The records of these patients were retrieved from the Cancer Registry Database of the Albany Medical College and retrospectively analysed. Survival analysis was performed using the Kaplan-Meir method. The influence of several prognostic factors on survival was evaluated using the logrank test.
There were 51 patients, (30 men), mean age 64 years (range 37 to 85 years). Operative mortality was 2.2 years. The distribution of age, sex, and cell type was similar between the patients with N2 diseas and 241 other patients without N2 involvement, who underwent lung resection in the same time period. Advanced overall stage and advanced T stage were significantly more common in the presence of N2 diseease (P<0.001), and pneumonectomy was more commonly employed in the presence of N2 disease (P<0.001). Overall 5 year survival was 20.3%. Survival was not influenced by stage, T stage, cell type, type of lung resection or the application of multimodality treatment.
The study confirms the poor prognosis associated with lung cancer with N2 involvement of the mediastinum. The lack of prognostic importance of cell type, disease stage and type of lung resection suggests that in advanced lung cancer the important factor in prognosis is the presence of extrapulmonary disease.
The low operative mortality and the 20.3% 5 year survival justifies surgical resection for those patients who are found at intraoperative pathological staging to have N2 disease.
Adebambo Kadri, None.