Impact of main bronchial lymph node involvement in pathological T1-2N1M0 non-small-cell lung cancer: multi-institutional survey by the Japan National Hospital Study Group for Lung Cancer.
OBJECTIVE
According to the TNM classification revised in 1997, stage II non-small-cell lung cancer (NSCLC) has an unfavorable prognosis. The purpose of this study was to analyze the prognostic factors for pathological T1-2N1M0 patients with NSCLC and elucidate the significance of main bronchial lymph nodes involvement.


METHODS
This retrospective study analyzed patients in a prospective database of cases from an 11-year period (operations from 1992 to 2002, follow-up data until March 2008) obtained from the Japan National Hospital Study Group for Lung Cancer. Among them, a total of 319 patients with pathological T1-2N1M0 disease were identified, and all dissected lymph nodes were classified using the Naruke map.


RESULTS
The cumulative overall 5-year survival rate for patients with intralobar or interlobar lymph node involvement (n = 266) was 56.8%, and that for those with main bronchial lymph node involvement (n = 53) was 40.4% (P = 0.002). Among patients with multiple-station N1 nodal involvement including the main bronchial lymph nodes, patients with a lower lobe tumor (n = 12) had a significantly worse prognosis than those with an upper lobe tumor (n = 9) (13.3% vs. 55.6%, P = 0.033). Multivariate analysis demonstrated that age, histology, tumor size, and main bronchial lymph node involvement were independent prognostic factors for patients with pathological T1-2N1M0 disease.


CONCLUSIONS
Involvement of the main bronchial lymph nodes is a significant factor to predict a worse prognosis in pathological T1-2N1M0 patients with NSCLC.
Maeda
Hajime
H
Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan. maedah@toneyama.hosp.go.jp
Fukai
Shimao
S
Matsumura
Akihide
A
Kawashima
Osamu
O
Watanabe
Takehiro
T
Yamanda
Takeshi
T
Okabayashi
Kan
K
Fujita
Yuka
Y
Tamura
Atsuhisa
A
Kawahara
Masaaki
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome