Impact of skip mediastinal lymph node metastasis on outcomes after resection for primary lung cancer.

Autor: Taylor M; Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK. Electronic address: Marcus.taylor1@nhs.net., Soliman N; Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK., Paoletti E; Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK., King M; Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK., Crosbie PAJ; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK., Granato F; Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.
Jazyk: angličtina
Zdroj: Lung cancer (Amsterdam, Netherlands) [Lung Cancer] 2023 Oct; Vol. 184, pp. 107341. Date of Electronic Publication: 2023 Aug 09.
DOI: 10.1016/j.lungcan.2023.107341
Abstrakt: Objectives: Patients with non-small cell lung cancer and nodal disease are a heterogeneous group with varied patterns of disease. The aim of this study was to assess long-term outcomes of patients with skip N2 disease in comparison to those with N1 or non-skip N2 disease.
Materials and Methods: A retrospective review of 445 patients undergoing anatomical lung resection for primary lung cancer between 2012 and 2019 with post-operative histological confirmation of nodal disease was undertaken. Log rank analysis was used to assess differences in estimated median overall survival according to nodal status. Multivariable Cox regression analysis was performed to determine whether skip N2 disease was independently associated with overall survival.
Results: Mean patient age was 67.0 years (standard deviation ± 9.2 years) and 48.1% (n = 214) were male. In total, 20.7% (n = 92) of patients had N1 disease, 32.1% (n = 143) had skip N2 disease and 47.2% (n = 210) had non-skip N2 disease. Post-operative upstaging took place in 33.0% (n = 147) of patients. Median follow-up time was 35 months (interquartile range 14-68 months). Skip N2 patients had significantly longer estimated median overall survival in comparison to their non-skip N2 counterparts (47 months vs 28 months, log rank analysis p = 0.029) and non-skip N2 disease remained independently associated with reduced overall survival after multivariable analysis (hazard ratio 1.421, 95% confidence interval 1.060-1.907, p = 0.019).
Conclusion: Skip N2 disease is a positive prognostic factor for patients with N2 lung cancer, suggesting that lung cancer staging guidelines should consider separating N2 disease into additional subgroups in order to improve prognostic accuracy.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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