Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer

Abstract OBJECTIVES The prognosis of patients with mediastinal lymph node (LN) metastasis (pN2 stage III disease) is still unsatisfactory. Both systemic and local recurrence should be prevented after curative surgery. The aim of this study was to explore the pattern of recurrence in patients with completely resected pN2 non-small-cell lung cancer (NSCLC) in the era of adjuvant chemotherapy. METHODS We investigated 337 patients with completely resected cN0-1 and pN2 NSCLC from 2005 to 2016 at National Cancer Center Hospital, Japan. The patterns of recurrence were compared between patients who were managed by observation alone and those with adjuvant chemotherapy. In patients with regional LN recurrence, the pattern and site of recurrence were also explored. RESULTS There were 195 (58.5%) men and 142 (41.5%) women with a mean age of 63.2 years. Fifty-five (16.3%) patients developed only regional LN recurrence, 116 (32.6%) patients developed only distant recurrence and 65 (19.3%) patients developed both regional LN recurrence and distant recurrence. The difference in the pattern of recurrence between patients with observation alone and those with adjuvant chemotherapy was not statistically significant (P = 0.145). As for the pattern of regional LN recurrence, 68 (20.2%) patients had LN recurrence inside the systematic nodal dissection area. CONCLUSIONS Regional LN recurrence was observed in >30% of patients with completely resected pN2 NSCLC. About 20% of patients had recurrence inside the systematic nodal dissection area. Postoperative radiotherapy might be considered as an additional treatment strategy for these patients.

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Long-term survivors with pN2 non-small cell lung cancer after a complete resection with a systematic mediastinal node dissection

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(98)00162-6 ◽

1998 ◽

Vol 14 (2) ◽

pp. 152-155 ◽

Cited By ~ 13

Author(s):

Tokujiro Yano ◽

Yasuro Fukuyama ◽

Hideki Yokoyama ◽

Shinji Kuninaka ◽

Yasuhiro Terazaki ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Complete Resection ◽

Small Cell ◽

Node Dissection ◽

Small Cell Lung ◽

Mediastinal Node ◽

Long Term Survivors

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Surgical management of non-small-cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease)

Lung Cancer ◽

10.1016/0169-5002(94)90615-7 ◽

1994 ◽

Vol 11 (3-4) ◽

pp. 334-335

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Surgical Management ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Node Metastasis ◽

Mediastinal Node ◽

N2 Disease

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Permissible Outcomes of Lobe-Specific Lymph Node Dissection for Elevated Carcinoembryonic Antigen in Non-Small Cell Lung Cancer

Medicina ◽

10.3390/medicina57121365 ◽

2021 ◽

Vol 57 (12) ◽

pp. 1365

Author(s):

Hiroaki Kuroda ◽

Junji Ichinose ◽

Katsuhiro Masago ◽

Yusuke Takahashi ◽

Takeo Nakada ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Carcinoembryonic Antigen ◽

Cell Lung Cancer ◽

Early Stage ◽

Disease Free Survival ◽

Small Cell ◽

Small Cell Lung ◽

Nodal Dissection ◽

Nsclc Patients

Background and Objectives: Lobe-specific nodal dissection (L-SND) is currently acceptable for the dissection of early-stage non-small cell lung cancer (NSCLC) but not for cancers of more advanced clinical stages. We aimed to assess the efficacy of L-SND, compared to systemic nodal dissection (SND). Materials and Methods: We retrospectively collected the clinical data of patients with carcinoembryonic antigen (CEA) abnormality who underwent complete resection of NSCLC via lobectomy or more in addition to either SND or L-SND at two cancer-specific institutions from January 2006 to December 2017. Results: A total of 799 patients, including 265 patients who underwent SND and 534 patients who underwent L-SND, were included. On multivariate analysis, thoracotomy, more than lobectomy, cN1-2, advanced pathological stage, adjuvant treatment, and EGFR or ALK were strongly associated with SND. No significant differences were found in overall survival, disease-free survival, and overtime survival after propensity adjustment (p = 0.09, p = 0.11, and p = 0.50, respectively). There were no significant differences in local (p = 0.16), regional (p = 0.72), or distant (p = 0.39) tumor recurrence between the two groups. Conclusions: SND did not improve the prognosis of NSCLC patients with CEA abnormality. Complete pulmonary resection via L-SND seems useful for NSCLC patients with CEA abnormality.

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