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Outcomes of initial surgery in patients with clinical N2 non-small cell lung cancer who met 4 specific criteria

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Abstract

Purpose

The role of surgery for patients with non-small cell lung cancer (NSCLC) with clinical mediastinal lymph node metastasis (N2) remains controversial. We specified 4 criteria for performing initial surgery in these patients (single-station N2, non-bulky N2, N2 with regional mode of spread, and N2 without N1) and examined the outcomes to validate the treatment options.

Methods

Between September 2002 and December 2010, of 1290 patients who underwent complete resection for NSCLC, 808 patients underwent initial standard resection, including 779 patients with cN0–1 and 29 with cN2. We compared the outcomes, and evaluated patients with cN2–pN2.

Results

The median follow-up was 45.5 months (3–119 months). Seventy (9.0 %) and 24 (82.8 %) patients had p-N2 in the cN0–1 and cN2 groups, respectively (p < 0.0001). The 5-year disease-free survival (DFS) rates in the cN0–1 and cN2 groups were 73.3 and 50.6 %, respectively (p = 0.0053), and the 5-year overall survival (OS) rates were 81.3 and 71.1 %, respectively (p = 0.051). The 5-year DFS and OS of patients with cN2–pN2 were 52.5 and 72.6 %, respectively.

Conclusions

Patients with clinical N2 disease based on our criteria represent a highly specific group with a favorable prognosis. Resection should therefore be the initial treatment for these patients.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan

    Tomohiro Maniwa, Shoji Takahashi, Mitsuhiro Isaka & Yasuhisa Ohde

  2. Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan

    Masahiro Endo

Authors
  1. Tomohiro Maniwa
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  2. Shoji Takahashi
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  3. Mitsuhiro Isaka
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  4. Masahiro Endo
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  5. Yasuhisa Ohde
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Correspondence to Tomohiro Maniwa.

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Tomohiro Maniwa and the other co-authors have no conflicts of interest to declare in association with this study.

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Maniwa, T., Takahashi, S., Isaka, M. et al. Outcomes of initial surgery in patients with clinical N2 non-small cell lung cancer who met 4 specific criteria. Surg Today 46, 699–704 (2016). https://doi.org/10.1007/s00595-015-1268-2

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  • DOI: https://doi.org/10.1007/s00595-015-1268-2

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