title: The Prognostic Significance of Metastasis to Lymph Nodes in Aortopulmonary Zone (Stations 5 and 6) in Completely Resected Left Upper Lobe Tumors.
abstract: BACKGROUND
  We investigated the prognostic effect of lymph nodes metastasis in aortopulmonary (AP) zone in resected non-small cell lung cancer of the left upper lobe (LUL).
  
  
  METHODS
  Between 1998 and 2010, 181 patients with LUL carcinoma underwent complete resection and were retrospectively analyzed. The patients were divided into four groups according to N status: N0 (n = 68, 37.6%), N1 (n = 64, 35.3%), N2(5,6+) (only metastasized to stations 5 and/or 6, n = 36, 19.9%), and N2(7+) (only metastasized to stations 7, n = 13, 7.2%). N1 were divided according to single and multiple (N1(single) n = 49, N1(multiple) n = 15) or peripheral and hilar (N1(peripheral) n = 39, N1(hilar) n = 25).
  
  
  RESULTS
  Overall 5-year survival rate was 55.1%. Five-year survivals were 76.1% for N0, 54.3% for N1, and 20.7% for N2. N1(peripheral) had a better survival than N1(hilar) (60.3 vs. 29.4%, p = 0.09). Five-year survival of N1(single) was 60.1%, whereas it was 36.6% for N1(multiple) (p = 0.02). Five-year survival rate was 24.6% for N2(5,6+). Skip metastasis for lymph nodes in AP zone (n = 13) was a factor of better prognosis as compared to nonskip metastasis (n = 23) (29.9 vs. 19.2%). There was no statistically significant difference between the N2(5,6+) and N1(hilar) (p = 0.772), although N1(peripheral) had a significantly better survival than N2(5,6+) (p = 0.02). AP zone metastases alone had a significantly worse survival than N1(single) (p = 0.008), whereas there was no statistically significant difference between the N1(multiple) and N2(5,6+) (p = 0.248). N2(7+) was not expected to survive 3 years after operation. They had a significantly worse prognosis than N2(5,6+) (p = 0.02).
  
  
  CONCLUSIONS
  LUL tumors with metastasis in the AP zone lymph nodes, especially skip metastasis, were associated with a more favorable prognosis than other mediastinal lymph nodes. However, the therapy of choice for lung cancer with N2(5,6+) has not been clarified yet.
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Necati
authors.initials: N
authors.lastname: Citak
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sayar
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Metin
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Songül
authors.initials: S
authors.lastname: Büyükkale
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Kök
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Okan
authors.initials: O
authors.lastname: Solak
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Sibel
authors.initials: S
authors.lastname: Yurt
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Training and Research Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Atilla
authors.initials: A
authors.lastname: Gürses
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011651:Pulmonary Artery / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis