title: Long-term survival with surgery as part of a multimodality approach for N3 lung cancer.
abstract: OBJECTIVE
  The extension of non-small-cell lung cancer (NSCLC) to supraclavicular (SC) and contralateral (CL) mediastinal lymph nodes is termed N3 and usually forbids surgical resection. However, scarce surgical series have reported encouraging results, and we sought to analyse our experience with this particular subgroup of patients.
  
  
  METHODS
  We retrospectively reviewed the charts of 5857 patients undergoing surgery for NSCLC during the last 30 years in two French centres. Eleven patients presenting with pathological-N3 were found, and more closely analysed concerning lymphatic spread, surgical indication and prognosis.
  
  
  RESULTS
  N3 consisted of tumoural extension to the SC (n = 5), CL mediastinal (n = 5) or both (SC + CL, n = 1) stations. Patients underwent induction treatment with chemotherapy alone (n = 4), chemoradiotherapy (n = 3) or first-line surgery (n = 4). All patients underwent a complete surgical resection of the tumour associated with ipsilateral systematic mediastinal lymph node dissection. Additional resection of N3 lymph nodes was performed in 8 cases. Adjuvant treatment included chemoradiotherapy (n = 6), chemotherapy alone (n = 1) or radiation therapy alone (n = 1). All 5 patients with SC-N3 presented with ipsilateral disease; 3 of them survived 5 years. Four patients with CL-N3 presented with left-sided tumour and nodal extension to the 4R station, and none of them survived.
  
  
  CONCLUSIONS
  Some N3-patients with specific anatomical location may benefit from multimodality treatment including surgery. These results support further prospective studies for selected N3-patients.
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes University, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.forename: Pierre
authors.initials: P
authors.lastname: Mordant
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fabre-Guillevin
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.forename: Christophe
authors.initials: C
authors.lastname: Foucault
authors.forename: Antoine
authors.initials: A
authors.lastname: Dujon
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017741:Survivors
keywords: Multimodality therapy; N3 disease; Non-small-cell lung cancer; Surgery