Is there a subset of patients with preoperatively diagnosed N2 non-small cell lung cancer who might benefit from surgical resection?
The role of surgery in the treatment of preoperatively diagnosed N2 non-small cell lung cancer remains controversial. This study sought significant prognostic factors to select candidates for surgery and assess prognosis.Methods:
The study population included 277 patients who underwent primary resection (192) or induction chemotherapy followed by surgery (85) for preoperatively diagnosed, potentially resectable N2 non-small cell lung cancer. N2 descriptors were prospectively recorded. Kaplan-Meier curves were used to evaluate survival, and statistical significance of differences between curves was assessed by log-rank test. Cox regression was used for multivariate analyses.Results:
Preoperative significant prognostic factors were number of mediastinal node levels involved (P < .001), symptom severity (P = .013), clinical T (P = .041), and induction chemotherapy (P = .001). Three groups with different prognoses were based on individual prognostic score. The group that did best had a median survival of 29.6 months. Postoperative predictors of survival were pathologic T (P = .003), tumor residue (P = .034), and number of mediastinal nodes involved (P < .001). Of 3 groups with different prognoses, the most favorable had a median survival as long as 42 months.Conclusion:
This study provides a practical tool that uses significant prognostic factors to predict which patients with preoperatively diagnosed N2 non-small cell lung cancer have better prognoses. Because patients with the favorable prognostic factors showed good long-term survival and excellent local disease control, surgery should still play an important role in the multimodality treatment of these patients.