Alfonso Fiorelli1, Dariusz Sagan2, Lukasz Mackiewicz2, Lucio Cagini3, Elisa Scarnecchia3, Paolo Chiodini4, Francesco Paolo Caronia5, Francesco Puma3, Mario Santini1, Mark Ragusa3. 1. Department of Thoracic Surgery, Second University of Naples, Naples, Italy. 2. Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland. 3. Thoracic Surgery Unit, Department of Surgery, University of Perugia, Perugia, Italy. 4. Department of Medical Statistics, Second University of Naples, Naples, Italy. 5. Thoracic Surgery Unit, Department of Thoracic Surgery, Istituto Oncologico del Mediterraneo "IOM", Catania, Italy.
Abstract
BACKGROUND: To evaluate the incidence, predictors, and survival of unexpected pN2 disease in patients with clinical stage I non-small cell lung cancer. METHODS: This is a retrospective observational multicenter study on all consecutive patients operated for clinical stage I non-small cell lung cancer from January 2006 to December 2012. Medical records were reviewed to investigate the incidence and risk factors for unexpected pN2 disease. Then, the survival of patients with unexpected pN2 disease was statistically compared with that of patients with clinical N2 disease operated after induction therapy in the same period. RESULTS: Our study population counted 901 patients. An incidence of 12% (108/901) unexpected pN2 disease was found. Among 3,389 lymph nodes sampled, 124 distinct metastases were found. Of the 108 patients, 92 (85%) had metastases in single N2 station and 16 (15%) patients had disease in multiple N2 stations; 47 (44%) had pN2 disease without pN1 involvement (skip metastases) and 61/108 (56%) had also pN1 metastases. Factors associated with unexpected pN2 disease were central tumor location (p < 0.003), cT2a (p < 0.0001) and pT2a stage (p < 0.0001), pN1 disease (p = 0.004), and a standard uptake value > 4.0 (0.007). Patients with pN2 disease compared with patients with cN2 disease presented a better median overall survival (56 versus 20 months; p = 0.001) and disease-free survival (46 versus 11 months; p < 0.0001). CONCLUSIONS: The preoperative effort to discover unexpected pN2 disease in patients with clinical stage I non-small cell lung cancer is not justified, considering their good survival. Thus, preoperative invasive mediastinal procedures in such cases are not indicated. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: To evaluate the incidence, predictors, and survival of unexpected pN2 disease in patients with clinical stage I non-small cell lung cancer. METHODS: This is a retrospective observational multicenter study on all consecutive patients operated for clinical stage I non-small cell lung cancer from January 2006 to December 2012. Medical records were reviewed to investigate the incidence and risk factors for unexpected pN2 disease. Then, the survival of patients with unexpected pN2 disease was statistically compared with that of patients with clinical N2 disease operated after induction therapy in the same period. RESULTS: Our study population counted 901 patients. An incidence of 12% (108/901) unexpected pN2 disease was found. Among 3,389 lymph nodes sampled, 124 distinct metastases were found. Of the 108 patients, 92 (85%) had metastases in single N2 station and 16 (15%) patients had disease in multiple N2 stations; 47 (44%) had pN2 disease without pN1 involvement (skip metastases) and 61/108 (56%) had also pN1metastases. Factors associated with unexpected pN2 disease were central tumor location (p < 0.003), cT2a (p < 0.0001) and pT2a stage (p < 0.0001), pN1 disease (p = 0.004), and a standard uptake value > 4.0 (0.007). Patients with pN2 disease compared with patients with cN2 disease presented a better median overall survival (56 versus 20 months; p = 0.001) and disease-free survival (46 versus 11 months; p < 0.0001). CONCLUSIONS: The preoperative effort to discover unexpected pN2 disease in patients with clinical stage I non-small cell lung cancer is not justified, considering their good survival. Thus, preoperative invasive mediastinal procedures in such cases are not indicated. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Alfonso Fiorelli; Immacolata Mauro; Gaetano Cicchitto; Aldo Prencipe; Mario Polverino; Vincenzo Giuseppe Di Crescenzo; Mario Santini Journal: Ann Transl Med Date: 2019-07
Authors: John M Varlotto; Isabel Emmerick; Rick Voland; Malcom M DeCamp; John C Flickinger; Debra J Maddox; Christine Herbert; Molly Griffin; Paul Rava; Thomas J Fitzgerald; Paulo Oliveira; Jennifer Baima; Rahul Sood; William Walsh; Lacey J McIntosh; Feiran Lou; Mark Maxfield; Negar Rassaei; Karl Uy Journal: Front Oncol Date: 2020-05-26 Impact factor: 6.244