Prognostic Importance of the Lymph Node Factor in Surgically Resected non-small Cell Lung Cancer
19 February 2018
10 September 2018
02 November 2018 (online)
Background Patients with N1 non-small cell lung cancer represent a heterogeneous population. The aim of this study is to determine the difference of survival rate between subtypes of N1 disease in surgically resected non-small cell lung cancer patients and to compare the survival in these patients with multi-N1 and single N2 (skip metastasis) disease.
Methods Patients who underwent anatomical pulmonary resection in our institution between 2007 and 2014 with a pathological diagnosis of N1 and single N2 positive non-small cell lung cancer were included in the study. N1 positive patients were divided into three groups as single hilar; single interlobar, lobar, or segmental; and multiple N1 positive patients. These groups were compared among themselves as well as with incidentally found single N2 patients.
Results A total of 1,742 patients who had non-small cell lung cancer underwent anatomical lung resection. The survival was better in single hilar lymph nodes than other subtypes of N1 disease (p = 0.015). There was no statistically significant difference in terms of survival between the other subtypes of N1 disease (p = 0.332). The difference in survival for single N2 disease compared with multi-N1 was not statistically significant (p = 0.054). Also, when we divided the groups as single and multi-N1, there was a significant difference in survival (p = 0.025).
Conclusion Single hilar lymph nodes with direct invasion have better survival rate than other subtypes of N1. Also, patients with multiple N1 positive lymph nodes have similar survival results compared with single N2 patients. Our results should be confirmed with larger series to better explain N1 disease.
- 1 Sobin LH, Gospodarowicz MK, Wittekind CH. International Union against Cancer. TNM classification of malignant tumours. 7th ed. 2009. Chichester, West Sussex, UK; Hoboken, NJ: Wiley-Blackwell; ; 2010
- 2 Asamura H, Chansky K, Crowley J. , et al; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming 8th Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2015; 10 (12) 1675-1684
- 3 Goldstraw P, Chansky K, Crowley J. , et al; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions; International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee Advisory Boards and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11 (01) 39-51
- 4 Jonnalagadda S, Smith C, Mhango G, Wisnivesky JP. The number of lymph node metastases as a prognostic factor in patients with N1 non-small cell lung cancer. Chest 2011; 140 (02) 433-440
- 5 Matsuguma H, Oki I, Nakahara R. , et al. Proposal of new nodal classifications for non-small-cell lung cancer based on the number and ratio of metastatic lymph nodes. Eur J Cardiothorac Surg 2012; 41 (01) 19-24
- 6 Sun G, Xue L, Wang M, Zhao X. Lymph node ratio is a prognostic factor for non-small cell lung cancer. Oncotarget 2015; 6 (32) 33912-33918
- 7 Goldstraw P, Crowley J, Chansky K. , et al; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of Malignant Tumours. J Thorac Oncol 2007; 2 (08) 706-714
- 8 Beasley MB, Brambilla E, Travis WD. The 2004 World Health Organization classification of lung tumors. Semin Roentgenol 2005; 40 (02) 90-97
- 9 Shimada Y, Tsuboi M, Saji H. , et al. The prognostic impact of main bronchial lymph node involvement in non-small cell lung carcinoma: suggestions for a modification of the staging system. Ann Thorac Surg 2009; 88 (05) 1583-1588
- 10 Demir A, Turna A, Kocaturk C. , et al. Prognostic significance of surgical-pathologic N1 lymph node involvement in non-small cell lung cancer. Ann Thorac Surg 2009; 87 (04) 1014-1022
- 11 Maeshima AM, Tsuta K, Asamura H, Tsuda H. Prognostic implication of metastasis limited to segmental (level 13) and/or subsegmental (level 14) lymph nodes in patients with surgically resected nonsmall cell lung carcinoma and pathologic N1 lymph node status. Cancer 2012; 118 (18) 4512-4518
- 12 Cerfolio RJ, Bryant AS. Predictors of survival and disease-free survival in patients with resected N1 non-small cell lung cancer. Ann Thorac Surg 2007; 84 (01) 182-188 , discussion 189–190
- 13 Li Q, Zhan P, Yuan D. , et al. Prognostic value of lymph node ratio in patients with pathological N1 non-small cell lung cancer: a systematic review with meta-analysis. Transl Lung Cancer Res 2016; 5 (03) 258-264
- 14 Decaluwé H, Stanzi A, Dooms C. , et al; Leuven Lung Cancer Group. Central tumour location should be considered when comparing N1 upstaging between thoracoscopic and open surgery for clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg 2016; 50 (01) 110-117
- 15 Vansteenkiste JF, De Leyn PR, Deneffe GJ, Lerut TE, Demedts MG. Clinical prognostic factors in surgically treated stage IIIA-N2 non-small cell lung cancer: analysis of the literature. Lung Cancer 1998; 19 (01) 3-13
- 16 Casali C, Stefani A, Natali P, Rossi G, Morandi U. Prognostic factors in surgically resected N2 non-small cell lung cancer: the importance of patterns of mediastinal lymph nodes metastases. Eur J Cardiothorac Surg 2005; 28 (01) 33-38
- 17 Legras A, Mordant P, Arame A. , et al. Long-term survival of patients with pN2 lung cancer according to the pattern of lymphatic spread. Ann Thorac Surg 2014; 97 (04) 1156-1162
- 18 Gunluoglu MZ, Demir A, Turna A. , et al. Extent of lung resection in non-small lung cancer with interlobar lymph node involvement. Ann Thorac Cardiovasc Surg 2011; 17 (03) 229-235
- 19 Park S, Cho S, Yum SW, Kim K, Jheon S. Comprehensive analysis of metastatic N1 lymph nodes in completely resected non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2015; 21 (05) 624-629
- 20 Marra A, Hillejan L, Zaboura G, Fujimoto T, Greschuchna D, Stamatis G. Pathologic N1 non-small cell lung cancer: correlation between pattern of lymphatic spread and prognosis. J Thorac Cardiovasc Surg 2003; 125 (03) 543-553
- 21 Mordant P, Pricopi C, Legras A. , et al. Prognostic factors after surgical resection of N1 non-small cell lung cancer. Eur J Surg Oncol 2015; 41 (05) 696-701
- 22 World Health Organization. International Agency for Research on Cancer (IARC) GLOBOCAN 2012. Estimated cancer incidence, mortality and prevalence worldwide in 2012. Available at: globocan.iarc.fr/Pages/fact_sheets_cancer.aspx . Accessed March 27, 2017
- 23 Sawabata N. Prognosis of lung cancer patients in Japan according to data from the Japanese Joint Committee of Lung Cancer Registry. Respir Investig 2014; 52 (06) 317-321
- 24 Igata F, Uchino J, Fujita M, Iwasaki A, Watanabe K. Clinical features of lung cancer in Japanese patients aged under 50. Asian Pac J Cancer Prev 2016; 17 (07) 3377-3380