title: Prognostic significance of surgical-pathologic N1 lymph node involvement in non-small cell lung cancer.
abstract: BACKGROUND
  Patients with N1 non-small cell lung cancer represent a heterogeneous population with varying long-term survival. To better define the importance of N1 disease and its subgroups in non-small cell lung cancer staging, we analyzed patients with N1 disease using the sixth edition and proposed seventh edition TNM classifications.
  
  
  METHODS
  From January 1995 to November 2006, 540 patients with N1 non-small cell lung cancer who had at least lobectomy with systematic mediastinal lymphadenectomy were analyzed retrospectively.
  
  
  RESULTS
  For completely resected patients, the median survival rate and 5-year survival rate were 63 months and 50.3%, respectively. The 5-year survival rates for patients with hilar N1 (station 10), interlobar (station 11), and peripheral N1 (stations 12 to 14) involvement were 39%, 51%, and 53%, respectively. Patients with hilar lymph node metastasis showed a shorter survival period than patients with peripheral lymph node involvement (p = 0.02). Patients with hilar zone N1 (stations 10 and 11) involvement tended to show poorer survival than patients with peripheral zone N1 (12 to 14) metastasis (p = 0.08). Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (5-year survival 39% versus 51%, respectively, p = 0.01). Patients with multiple-zone N1 involvement showed poorer survival than patients with single-zone N1 metastasis (p = 0.04). A significant survival difference was observed between N1 patients with T1a versus T1b tumors (p = 0.02). Multivariate analysis revealed that only multiple-station lymph node metastasis was predictive of poor prognosis (p = 0.05).
  
  
  CONCLUSIONS
  Multiple-station versus single-station N1 disease and multiple-zone versus single-zone N1 involvement indicate poorer survival rate. Patients with hilar lymph node involvement had lower survival rates than patients with peripheral N1. The impact of T factor seemed to be veiled by the heterogenous nature of N1 disease. Further studies of adjusted postoperative strategies for different N1 subgroups are warranted.
authors.affiliation: Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey. dradalet@hotmail.com
authors.forename: Adalet
authors.initials: A
authors.lastname: Demir
authors.forename: Akif
authors.initials: A
authors.lastname: Turna
authors.forename: Celalettin
authors.initials: C
authors.lastname: Kocaturk
authors.forename: Mehmet Zeki
authors.initials: MZ
authors.lastname: Gunluoglu
authors.forename: Umit
authors.initials: U
authors.lastname: Aydogmus
authors.forename: Nur
authors.initials: N
authors.lastname: Urer
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Bedirhan
authors.forename: Atilla
authors.initials: A
authors.lastname: Gurses
authors.forename: Seyit Ibrahim
authors.initials: SI
authors.lastname: Dincer