[Significance of pulmonary lymph node metastases in locally advanced non-small cell lung cancer].
BACKGROUND
The locally advanced (T3 - 4) non-small cell lung cancer with pulmonary lymph node metastases (N1) is a mixture of different subgroups of disease with varying pattern of tumor extension and long-term survival rates.


METHODS
We retrospectively reviewed hospital records and follow-up data of 181 patients operated on between 1990 and 1995 with pathological stage IIIA-pT3N1 and IIIB-pT4N1. Median age was 62 years (range 34 - 80).


RESULTS
The operative mortality was 3.7 %. The analysis was carried out on the 181 hospital survivors. The operative procedure was a pneumonectomy in 110 cases (60.8 %) and a lobectomy/bilobectomy in 71 (39.26 %). The pathological stage according to the UICC TNM-Classification of 1997 was T3N1 in 128 (70.7 %) and T4N1 in 53 (29.3 %). We observed a metastatic involvement of the hilar, interlobar and lobar lymph nodes in 44 (24.3 %), 17 (9.4 %), and 27 (14.9 %) patients, respectively, whereas a direct infiltration in 93 patients (51.4 %). The actuarial overall 3-, 5- and 10-year survival rates for N1 hilar was 23 %, 13 % and 8 %, for N1 interlobar was 18 %, 6 % and 0 %, for N1 lobar was 48 %, 37 % and 22 %, and for N1 direct was 32 %, 27 % and 21 %, respectively. The involvement of hilar lymph nodes correlates with a worse prognosis (p =.0366).


CONCLUSIONS
Metastases to the hilar lymph nodes in locally advanced NSCLC can be considered an initial N2-disease and should be treated correspondingly. Lymph node involvement by direct invasion is associated with a relatively more favourable prognosis for the patients.
Marra
A
A
Abteilung für Thoraxchirurgie und thorakale Endoskopie, Ruhrlandklinik, Essen, Germany.
Hillejan
L
L
Pöttgen
C
C
Zaboura
G
G
Fechner
S
S
Greschuchna
D
D
Stamatis
G
G
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors