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Thorac Cardiovasc Surg 2014; 62(02): 126-132
DOI: 10.1055/s-0033-1338132
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Analysis of Predictive Factors for Postoperative Survival for Non Small Cell Lung Carcinoma Patients with Unexpected Mediastinal Lymph Nodes Metastasis

Shaohua Wang
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
2   Department of Thoracic Surgery, Shanghai First People's Hospital, Shanghai Jiaotong University, Shanghai, China
,
Wenyong Zhou
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
,
Hui Zhang
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
,
Mingchuan Zhao
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
,
Xiaofeng Chen
1   Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
› Author Affiliations
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Publication History

09 November 2012

06 February 2013

Publication Date:
12 April 2013 (online)

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Abstract

Objectives To discuss the predictive factors of postoperative survival for non small cell lung carcinoma (NSCLC) patients with clinical N0 stage but postoperative pathological N2 stage (cN0–pN2).

Methods From January 1, 2005, to December 31, 2009, the clinical data of NSCLC patients with cN0–pN2 after radical surgery were retrospectively collected, and their survival information was collected through follow-up. The expiration date for follow-up was December 31, 2011. The predictive factors of postoperative survival for NSCLC patients with unexpected mediastinal lymph node metastasis were analyzed using Cox proportional hazards regression.

Results A total of 263 patients were enrolled. The follow-up rate was 91.63%. The overall 1-, 3-, and 5-year survival rates were 94.6, 55.2, and 26.3%, respectively. Video-assisted thoracotomy surgery (VATS; odds ratio [OR] 0.659; 95% confidence interval [CI] 0.469 to 0.927; p = 0.017), multiple stations of metastatic mediastinal lymph nodes (OR 1.605; 95% CI 1.180 to 2.183; p = 0.003), and no adjuvant chemotherapy (OR 1.576; 95% CI 1.105 to 2.246; p = 0.012) were independent predictive factors for unexpected N2 patients. The median survival after VATS was superior to that after thoracotomy for patients with a single station of metastatic mediastinal lymph node (48.45 m vs 37.34 m, p = 0.018). The median survival without any adjuvant chemotherapy was inferior to that after adjuvant chemotherapy for patients with multiple stations of metastatic mediastinal lymph nodes (20.32 m vs 31.55 m, p = 0.001).

Conclusion The postoperative survival for NSCLC patients with cN0–pN2 was related to operational method, adjuvant chemotherapy, and the number of metastatic mediastinal lymph node stations. Patients with a single station of metastatic mediastinal lymph node are likely to benefit from VATS, whereas patients with multiple stations of metastatic mediastinal lymph nodes are likely to benefit from adjuvant chemotherapy.

Keywords

non small cell lung cancer - staging - surgery - prognosis
 

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