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Survival Analysis in N2 + Patients for Whom Surgical Resection Was Performed

Year 2019, Volume: 5 Issue: 1, 104 - 111, 01.01.2019
https://doi.org/10.17954/amj.2018.1131

Abstract

Objective: This study aimed to demonstrate survival assessment and determine survival of the number of metastatic stations which N2 lymph node station was involvement.Material and Methods: Ninety six 10.6% patients with N2 lymph node metastasis in 901 patients who had been operated for Non-Small Cell Lung Cancer NSCLC at hospital from January 2009 to October 2013, were included in the study. The patients were analized under two main headings. In the first title the survival analysis was performed depending on single station or multiple stations of lymph node involvement. In the second title patients were divided into 5 groups according to metastatic lymph node stations. Group 1 was composed of superior No 2&4 stations metastases 20.8% , Group 2 was aorticopulmonary window No 5&6 stations metastases 26% , Group 3 was central No 7 station 13.5% , Group 4 was inferior No 8&9 stations metastases 14.6% and Group 5 was multiple station metastases were determined 25% .Results: Average survival time was 33.3 months and the median survival time was 30.8 months. In patients with mediastinal lymph node metastasis, comparison of survival difference in single-multiple stations; median survival of 55.7 months in single station and median survival of 25.5 months in multiple stations has been found. Single station involvement was determined to caused statistically significant better survival p

References

  • Spira A, Ettinger DS. Multidisciplinary management of lung cancer. N Engl J Med 2004; 350(4):379-92.
  • Martini N, Flehinger BJ, Zaman MB, Beattie EJ Jr. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Thorac Surg 1983; 198(3):386-97.
  • Shields TW. Lymphatics of the lungs, In: Shields TW, ed. General thoracic surgery. 6th ed. Baltimore, Philadelphia, London: William & Wilkins 2005,105-12.
  • Watanabe Y, Hayashi Y, Shimizu J, Oda M, Iwa T. Mediastinal nodal involvement and prognosis of non- small cell lung cancer. Chest 1991; 100(2):422-8.
  • Tsubota N, Yoshimura M. Skip metastasis and hidden N2 disease in lung cancer: How successful is mediastinal dissection? Surg Today 1996; 26(3):169-72.
  • Shields TW. The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non-small cell carcinoma of the lung. J Thorac Cardiovasc Surg 1990; 99(1):48-53.
  • Goldstraw P, Mannam GC, Kaplan D, Michail P. Surgical management of nonsmall cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease). J Thorac Cardiovasc Surg 1994; 107(1):19-27.
  • Naruke T, Goya T, Tsuchiya R, Suemasu K. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg 1988; 46(6):603-10.
  • Watanabe Y, Oda M, Ohta Y, et al. Surgical results on N2 lung cancer with special reference to correlation between tumor size and extension of lymph node metastases. Kyobu Geka 1999; 52(11):895-900.
  • Ginsberg RJ. Multimodality therapy for Stage IIIA (N2) lung cancer. An overview. Chest 1993; 103(4):356-9.
  • Mountain CF. Surgery for stage IIIa-N2 non-small cell lung cancer. Cancer 1994; 73(10):2589-98.
  • Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non- small cell lung carcinomas: What is the significant node that affect survival? J Thorac Cardiovasc Surg 1999; 118(2):270-5.
  • Suziki K, Nagai K, Yoshida J, Nishimura M, Takahashi K, Nishiwaki Y. The prognosis of surgically resected N2 non-small cell lung cancer: The importance of clinical N status. J Thorac Cardiovasc Surg 1999; 118(1):145-53.
  • Riquet M, Manac’h D, Saab M, Le Pimbec-Barthes F, Dujon A, Debesse B. Factors determining survival in resected N2 lung cancer. Eur J Cardiothorac Surg 1995; 9(6):300-4.
  • Cangır AK. Akciğer kanserinde tanı ve evreleme. In:Kavukçu Ş, Ökten I, eds. Göğüs cerrahisi cilt: 2, 2nd ed. İstanbul: İstanbul Tıp Kitabevi; 2013:1073-91.
  • Zhong C, Yao F, Zhao H. Clinical outcomes of thoracoscopic lobectomy for patients with clinical N0 and pathologic N2 non-small cell lung cancer, Ann Thorac Surg 2013; 95(3):987–92.
  • 2014 NCCN guideline version 3. Non-small cell lung cancer chapter. Available at https://www.nccn.org/ professionals/physician_gls/f_guidelines.asp. October 2014. Accesed
  • Whitson BA, Groth SS, Maddous MA. Surgical assesment and intraoperative management of mediasten lymph nodes in non-small cell lung cancer. Ann Thorac Surg 2007; 84(3):1059–65.
  • Dogusoy I, Demirbag HC, Ilter H, Yildirim M, Yasaroglu M, Imamoglu O, et al. The role of mediastinoscopy in the staging of lung cancer. Türk Göğüs Kalp Damar Cer Derg 2008; 16(1):29-32.
  • Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997; 111(6):1718-23.
  • Takizawa T, Terashima M, Koike T, Akamatsu H, Kurika Y, Yokoyama A. Mediastinal lymph node metastazis in patients with clinical stage I peripheral non-small cell lung cancer. J Thorac Cardiovasc Surg 1997; 113(2):248-52.
  • Naruke T. Mediastinal lymph node dissection. General thoracic surgery. Baltimore, Philadelphia, London; In: Shields TW ed; William & Wilkins, 1995; 469-80.
  • Patterson GA, Piazza D, Pearson FG, et al. Significance of metastatic disease in subaortic lymph nodes. Ann Thorac Surg 1987; 43(2):155-9.

Cerrahi Rezeksiyon Uygulanmış N2 + Hastalarda Sağkalım Analizi

Year 2019, Volume: 5 Issue: 1, 104 - 111, 01.01.2019
https://doi.org/10.17954/amj.2018.1131

Abstract

Amaç: Bu çalışma, operasyon sonrası metastatik olduğu saptanan N2 lenf nodu istasyonlarının sağkalım değerlendirmesini ve hangi N2 istasyon tutulumunun sağkalımının daha iyi olduğunun gösterilmesini amaçlamıştır.Gereç ve Yöntemler: Hastanemizde Ocak 2009-Ekim 2013 tarihleri arasında küçük hücreli dışı primer akciğer kanseri nedeni ile opere edilen 901 hastadan N2 lenf nodu metastazı tespit edilmiş 96 %10,6 hasta çalışmamıza dahil edildi. Hastalar iki ana başlık altında incelendi. İlk başlıkta, lenf nodu istasyonu tutulumunun tek istasyon ve multipl istasyon olmasına göre incelendi. İkinci başlıkta ise metastatik lenf nodu istasyonlarına göre 5 gruba ayrılarak tutulumların sağkalıma etkileri değerlendirildi. Grup 1ʼde süperior No 2&4 istasyon metastazları % 20,8 , Grup 2ʼde aortikopulmoner pencere No 5&6 metastazları %26 , Grup 3’te santral No 7 istasyon metastazı %13,5 , Grup 4ʼde inferior No 8&9 istasyon metastazları %14,6 ve Grup 5'de multipl istasyon metastazları incelenmiştir %25 .Bulgular: Ortalama sağkalım süresi 33,3 ay ve median sağkalım süresi 30,8 ay olarak bulundu. Mediastinal lenf nodlarında metastaz tespit edilen hastalarda, tek-multipl istasyon sağkalım farkı karşılaştırmasında tek istasyon tutulumunda 55,7 ay ortalama sağkalım ve multipl istasyon tutulumunda ise 25,5 ay ortalama sağkalım olduğu tespit edildi. Tek istasyon tutulumunun istatistiksel olarak anlamlı pİ0,05 olarak daha iyi sağkalıma neden olduğu belirlendi. Grup 1 ve 2’nin Grup 3 ve 5 ile karşılaştırmasında istatistiksel olarak anlamlı pİ0,05 olduğu ve daha iyi sağkalıma neden olduğu görüldü.Sonuç: Tek istasyon N2 tutulumunda multipl istasyon tutulumuna göre daha iyi sağkalım süreleri beklenmelidir. Özellikle 7 numaralı istasyon tutulumunda azalmış sağkalım görüldüğünden pre-peri operatif süreçte mutlaka örneklenmesi gerekmektedir

References

  • Spira A, Ettinger DS. Multidisciplinary management of lung cancer. N Engl J Med 2004; 350(4):379-92.
  • Martini N, Flehinger BJ, Zaman MB, Beattie EJ Jr. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Thorac Surg 1983; 198(3):386-97.
  • Shields TW. Lymphatics of the lungs, In: Shields TW, ed. General thoracic surgery. 6th ed. Baltimore, Philadelphia, London: William & Wilkins 2005,105-12.
  • Watanabe Y, Hayashi Y, Shimizu J, Oda M, Iwa T. Mediastinal nodal involvement and prognosis of non- small cell lung cancer. Chest 1991; 100(2):422-8.
  • Tsubota N, Yoshimura M. Skip metastasis and hidden N2 disease in lung cancer: How successful is mediastinal dissection? Surg Today 1996; 26(3):169-72.
  • Shields TW. The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non-small cell carcinoma of the lung. J Thorac Cardiovasc Surg 1990; 99(1):48-53.
  • Goldstraw P, Mannam GC, Kaplan D, Michail P. Surgical management of nonsmall cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease). J Thorac Cardiovasc Surg 1994; 107(1):19-27.
  • Naruke T, Goya T, Tsuchiya R, Suemasu K. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg 1988; 46(6):603-10.
  • Watanabe Y, Oda M, Ohta Y, et al. Surgical results on N2 lung cancer with special reference to correlation between tumor size and extension of lymph node metastases. Kyobu Geka 1999; 52(11):895-900.
  • Ginsberg RJ. Multimodality therapy for Stage IIIA (N2) lung cancer. An overview. Chest 1993; 103(4):356-9.
  • Mountain CF. Surgery for stage IIIa-N2 non-small cell lung cancer. Cancer 1994; 73(10):2589-98.
  • Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non- small cell lung carcinomas: What is the significant node that affect survival? J Thorac Cardiovasc Surg 1999; 118(2):270-5.
  • Suziki K, Nagai K, Yoshida J, Nishimura M, Takahashi K, Nishiwaki Y. The prognosis of surgically resected N2 non-small cell lung cancer: The importance of clinical N status. J Thorac Cardiovasc Surg 1999; 118(1):145-53.
  • Riquet M, Manac’h D, Saab M, Le Pimbec-Barthes F, Dujon A, Debesse B. Factors determining survival in resected N2 lung cancer. Eur J Cardiothorac Surg 1995; 9(6):300-4.
  • Cangır AK. Akciğer kanserinde tanı ve evreleme. In:Kavukçu Ş, Ökten I, eds. Göğüs cerrahisi cilt: 2, 2nd ed. İstanbul: İstanbul Tıp Kitabevi; 2013:1073-91.
  • Zhong C, Yao F, Zhao H. Clinical outcomes of thoracoscopic lobectomy for patients with clinical N0 and pathologic N2 non-small cell lung cancer, Ann Thorac Surg 2013; 95(3):987–92.
  • 2014 NCCN guideline version 3. Non-small cell lung cancer chapter. Available at https://www.nccn.org/ professionals/physician_gls/f_guidelines.asp. October 2014. Accesed
  • Whitson BA, Groth SS, Maddous MA. Surgical assesment and intraoperative management of mediasten lymph nodes in non-small cell lung cancer. Ann Thorac Surg 2007; 84(3):1059–65.
  • Dogusoy I, Demirbag HC, Ilter H, Yildirim M, Yasaroglu M, Imamoglu O, et al. The role of mediastinoscopy in the staging of lung cancer. Türk Göğüs Kalp Damar Cer Derg 2008; 16(1):29-32.
  • Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997; 111(6):1718-23.
  • Takizawa T, Terashima M, Koike T, Akamatsu H, Kurika Y, Yokoyama A. Mediastinal lymph node metastazis in patients with clinical stage I peripheral non-small cell lung cancer. J Thorac Cardiovasc Surg 1997; 113(2):248-52.
  • Naruke T. Mediastinal lymph node dissection. General thoracic surgery. Baltimore, Philadelphia, London; In: Shields TW ed; William & Wilkins, 1995; 469-80.
  • Patterson GA, Piazza D, Pearson FG, et al. Significance of metastatic disease in subaortic lymph nodes. Ann Thorac Surg 1987; 43(2):155-9.
There are 23 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Baris Hekimoglu

Selim Sakir Erkmen Gulhan This is me

Yucel Akkas This is me

Leyla Nesrin Acar This is me

Sadi Kaya This is me

Publication Date January 1, 2019
Submission Date April 10, 2018
Published in Issue Year 2019 Volume: 5 Issue: 1

Cite

Vancouver Hekimoglu B, Gulhan SSE, Akkas Y, Acar LN, Kaya S. Cerrahi Rezeksiyon Uygulanmış N2 + Hastalarda Sağkalım Analizi. Akd Med J. 2019;5(1):104-11.