title: Nodal status at repeat mediastinoscopy determines survival in non-small cell lung cancer with mediastinal nodal involvement, treated by induction therapy.
abstract: OBJECTIVE
  Remediastinoscopy is a valuable tool in restaging non-small cell lung cancer after induction therapy for mediastinal nodal involvement as it provides pathological evidence of response and may select patients for subsequent thoracotomy. However, long-term survival data after remediastinoscopy are scarce.
  
  
  METHODS
  From November 1994 to April 2003, a remediastinoscopy was performed in 32 patients (29 men, 3 women) after induction therapy for locally advanced non-small cell lung cancer. Mean age was 67.8 years (range, 47-83). Neoadjuvant chemotherapy was given in 26 patients and chemoradiotherapy in 6. Follow-up data were completed in January 2005.
  
  
  RESULTS
  Remediastinoscopy was technically feasible in all patients. There were five false-negative remediastinoscopies, resulting in a sensitivity of 71%, specificity of 100% and accuracy of 84%. Follow-up was complete in all patients. Median survival time for the whole group was 21 months (95% confidence interval [CI] 9-33). Median survival time in patients with a positive remediastinoscopy was 7 months (95% CI 5-9), with a negative remediastinoscopy 41 months (95% CI 13-69), and with a false-negative remediastinoscopy 24 months (95% CI 5-43). The difference between positive and negative remediastinoscopies was highly significant (p=0.003). In the combined group of patients with positive and false-negative remediastinoscopies (n=17), median survival time was 8 months (95% CI 3-13). The difference with negative remediastinoscopy remained significant (p=0.012). In a multivariate analysis, including sex, age, histology and nodal status at repeat mediastinoscopy, only nodal status was a significant independent prognostic factor (p=0.015).
  
  
  CONCLUSIONS
  Remediastinoscopy is a valuable restaging procedure after induction therapy. Prognosis is poor in patients with persisting mediastinal nodal involvement, proven at repeat mediastinoscopy.
authors.affiliation: Department of Thoracic and Vascular surgery, University Hospital of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
authors.forename: Michèle
authors.initials: M
authors.lastname: De Waele
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendriks
authors.forename: Patrick
authors.initials: P
authors.lastname: Lauwers
authors.forename: Paul
authors.initials: P
authors.lastname: Ortmanns
authors.forename: Wim
authors.initials: W
authors.lastname: Vanroelen
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Morel
authors.forename: Paul
authors.initials: P
authors.lastname: Germonpré
authors.forename: Paul
authors.initials: P
authors.lastname: Van Schil
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D012074:Remission Induction / Q000379:methods; D016019:Survival Analysis