Prognostic spotlight on N1 disease in NSCLC patients and its relation with tumor characteristics

Year 2024, Volume: 41 Issue: 3, 636 - 640, 30.09.2024

İsmail Sarbay , Gizem Özçıbık Işık , Şebnem Batur , Burcu Kilic , H.volkan Kara , Ezel Ersen , Kamil Kaynak , Akif Turna

Abstract

Lung cancer is still one of the most common and potentially lethal cancers. N1 is considering a bad prognostic factor. We aimed to re-identify its prognostic aspects and its relation with the T descriptor. We have operated on 865 patients who were operated on for non-small cell lung cancer (NSCLC) between 2005-2019. Patients with any mediastinal lymph node and distal metastasis were excluded. A total of 667 T1-4N0-1M0 patients were investigated. Survival analysis was made via Cox regression. Five-year survival rate was 72% months in N1 patients. We have shown that increased tumor size and T score were related to higher incidence of N1 positivity T1 has the lowest rate while T3 and T4 have the highest (p<0.001). Lymphovascular invasion decreases overall survival (OR:0.540, p=0.008). The number of parenchymal and hilar lymph nodes was associated with survival regardless of the lymph node positivity (p=0.017). The mean survival of solitary hilar lymph node metastasis 129 months (95% Confidence Interval: 114-143 months) like N0 patients who had overall survival of 133 months (95% Confidence Interval: 125-142 months). Higher T stage is related with higher chance of N1 disease. Surgical and pathological LND from N1 stations are more important in these cases. N1 diseases with STAS and LVI positivity should be assessed with care, and one shall beware with potentially lower survival. Solitary hilar lymph node metastasis with no parenchymal lymph node metastasis had similar survival outcome to N0 patients which may indicate a need for reevaluation in staging.

Keywords

NSCLC, survival, lymph node dissection, parenchymal lymph nodes, N1 disease

Ethical Statement

This retrospective cohort study was approved by the institutional review board (file number 17109671-600-85480).

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