The prognosis of surgically resected N2 non-small cell lung cancer: The importance of clinical N status
The prognosis of surgically resected N2 non-small cell lung cancer: The importance of clinical N status
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DOI：
10.1016/s0022-5223(99)70153-4
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发表时间：
1999-07-01
影响因子：
6
通讯作者：
Nishiwaki, Y
中科院分区：
文献类型：
--
作者：
Suzuki, K;Nagai, K;Nishiwaki, Y
背景：多模式治疗N2非小细胞肺癌的临床试验正受到密切关注，该策略的可行性有待证实。方法：1986年1月~ 1997年7月，本院222例肺癌患者行手术治疗；这些患者最终被诊断为转移到同侧纵隔淋巴结，所有患者都进行了纵隔淋巴结清扫或取样。采用单变量和多变量分析分析16个临床病理因素，以确定切除N2疾病的显著预后因素，通过计算机断层扫描评估临床N状态。结果：总5年生存率为27%，总患者多变量分析显示4个显著预后因素（P < 0.05）：临床N2状态、切除不全、肿瘤较大、多发病变N2淋巴结，同时存在临床N2状态和病理多发N2淋巴结的32例患者5年生存率为5%，无上述因素的76例患者5年生存率为57% （P < 0.001）。结论：4个重要预后因素对手术切除N2病变的预后影响较大。这些因素应在N2肺癌临床试验报告中明确描述，通过计算机断层扫描评估的临床N状态应作为在同质人群中进行N2疾病临床试验的预后标准之一。
Background: Clinical trials dealing with multimodal strategy for N2 non-small cell lung cancer are now being watched,vith keen interest, and the feasibility of this strategy is to be confirmed. N2 lung cancer, however, is composed of several subgroups with different prognoses, The prognostic factors still remain controversial, Methods: Between January 1986 and July 1997, 222 patients with lung cancer underwent surgical intervention at our institute; these patients were eventually given a diagnosis of metastasis to ipsilateral mediastinal lymph nodes, All patients underwent mediastinal lymph node dissection or sampling. Sixteen clinicopathologic factors were investigated by univariable and multivariable analyses to identify significant prognostic factors among resected N2 disease, Clinical N status was evaluated by computed tomographic scan, Results: The overall 5-year survival was 27%, Multivariable analyses among overall patients revealed 4 significant prognostic factors (P < .05): clinical N2 status, incomplete resection, larger tumor size, and multiple diseased N2 nodes, Based on the result, 32 patients with both clinical N2 status and pathologic multiple N2 nodes showed a 5-year survival of 5%, whereas 76 patients with neither of the factors showed a 5-year survival of 57% (P < .001). Conclusion: The prognosis of surgically resected N2 disease varies tremendously according to the 4 significant prognostic factors. These factors should be clearly described in reporting clinical trials on N2 lung cancer, Clinical N status evaluated by computed tomographic scan should be 1 criterion to perform a clinical trial for N2 disease among a homogeneous population with respect to prognosis.