title: Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy: the microscopic seed of doubt.
abstract: OBJECTIVE
  The surgical treatment of residual N2 disease following induction radio-chemotherapy (IT) for locally advanced cIIIA-N2 non-small-cell lung cancer (NSCLC) is still debated. The long-term results after resection in a pN2 series are at the focus of this study.
  
  
  METHODS
  From January 1992 to December 2008, 161 consecutive pathologically proven Stage IIIA-N2 NSCLC patients underwent IT. Among these, 40 pN2s were included in this retrospective analysis. The associations between the mortality and the disease-free status with potential risk factors were explored by means of the Kaplan-Meier and Cox regression analysis.
  
  
  RESULTS
  Mean age and male/female ratio were 58.7 ± 9.7 years and 36/4, respectively. Twelve patients (30%) showed a clinical partial response and 28 (70%) showed stable disease. There was one (3%) perioperative death and four (10%) major complications. In the total group, the 3- and 5-year survival rates were 24.2% and 19.3%, respectively. The Cox regression analysis suggested that the macroscopic pN2 status proved to be a negative prognostic factor (hazard ratio (HR)=2.8, confidence interval (CI) 95%: 1.1-7.3; p=0.04). The recurrence rate flattened at 30.8% at the 3rd year. Furthermore, the bilobectomy-pneumonectomy group had a risk of relapse 6.9 times higher than the lobectomy group (CI 95%: 2.5-18.8; p < 0.001).
  
  
  CONCLUSIONS
  The persistence of disease at the N2 level after IT and surgery for cIIIa-N2 NSCLC does not exclude favorable outcome after resection, in particular in those patients with minor residual disease.
authors.affiliation: Department of General Thoracic Surgery, Catholic University, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Meacci
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cesario
authors.forename: Giacomo
authors.initials: G
authors.lastname: Cusumano
authors.forename: Filippo
authors.initials: F
authors.lastname: Lococo
authors.forename: Rolando
authors.initials: R
authors.lastname: D'Angelillo
authors.forename: Valentina
authors.initials: V
authors.lastname: Dall'armi
authors.forename: Stefano
authors.initials: S
authors.lastname: Margaritora
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Granone
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011013:Pneumonectomy / Q000379:methods; D012008:Recurrence; D016896:Treatment Outcome