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Masayoshi Inoue
Noriyoshi Sawabata
Shin-ichi Takeda
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Right arrow Lung - cancer

J Thorac Cardiovasc Surg 2004;127:1100-1106
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Results of surgical intervention for p-stage IIIA (N2) non–small cell lung cancer: Acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in the upper lobe

Masayoshi Inoue, MD, PhDa,*, Noriyoshi Sawabata, MD, PhDa, Shin-ichi Takeda, MD, PhDa, Mitsunori Ohta, MD, PhDb, Yuko Ohno, PhDc, Hajime Maeda, MD, PhDa

a Department of Thoracic Surgery, Toneyama National Hospital, Osaka, Japan
b Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan,
c Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Osaka, Japan

Received for publication June 26, 2003; revisions received August 14, 2003; accepted for publication September 9, 2003.

* Address for reprints: Masayoshi Inoue, MD, Department of Surgery, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka-city 560-8552, Osaka, Japan
masayoshinoue{at}hotmail.com

OBJECTIVES: Non–small cell lung cancer with mediastinal lymph node involvement is a heterogeneous entity different from single mediastinal lymph node metastasis to multiple nodes or extranodal disease. The objective of this study was to identify the subpopulation of patients with N2 disease who can benefit from surgical intervention.

METHODS: We reviewed 219 consecutive patients with N2 non–small cell lung cancer treated with a thoracotomy between November 1980 and June 2002 and retrospectively analyzed 154 of those who had p-stage IIIA disease and underwent a complete resection. Age, sex, side (right or left), histology, location (upper or middle-lower lobe), tumor size, c-N factor, and N2 level (single or multiple) were used as prognostic variables.

RESULTS: The 3- and 5-year survivals were 45.3% and 28.1%, respectively, in patients with p-stage IIIA (N2) disease. Survival for those with single N2 non–small cell lung cancer was significantly better than in those with multiple N2 disease (P = .0001), and patients with a tumor in the upper lobe showed a significantly longer survival than those with middle-lower lobe involvement (P = .0467). The 3- and 5-year survivals for patients with single N2 disease with a primary tumor in the upper lobe were 74.9% and 53.5%, respectively. A multivariate analysis with Cox regression identified 5 predictors of better prognosis: younger age, squamous cell carcinoma as determined by histology, primary tumor location in the upper lobe, c-N0 status, and a single station of mediastinal node metastasis.

CONCLUSION: Our results suggest that of the heterogeneity of N2 diseases, patients with single N2 disease with non–small cell lung cancer in the upper lobe are good candidates for pulmonary resection.




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