In: Lung Carcinoma18 Dec 2013
Stage II non-small cell lung cancer represents a group of patients with varying 5-year survival rates. Of 2,009 patients, we reviewed 58 patients with pTINlMO disease operated on from 1977 through 1994. The N1 status was refined into lymph node involvement by direct extension and/or involvement by metastases (lobar or hilar). The cumulative 5-year survival of all hospital survivors (n=57) was 45.7%. The 5-year survival of patients with N1 direct extension was superior to survival of patients with N1 metastases (68.6% vs 31.2%; p=0.0038). Survival of patients with N1 direct extension was better then survival of patients with N1 hilar metastases (p=0.0006), but did not differ from survival of patients with lobar metastases. Survival was not related to histologic features, sex, and type of resection. Recurrence of malignancy occurred less in patients with N1 direct extension. In patients with N1 hilar nodes, the most common pattern was distant metastases. Survival differs according to the type of lymph node involvement: “direct extension” seems to be an early stage of the disease, while lymph node metastases represent a more advanced form.
In 1986, the TNM classification for lung cancer was revised. In this new international staging system, T1N1M0 (formerly stage I) became stage II, because survival rates in this subset of patients were more comparable to rates in patients with former stage II disease. However, the surgical outcome in patients with present stage II disease is rather variable. Survival rates vary between 30% and 50% and seem to be related to lymph node involvement. Possibly, N1 disease does not represent a homogeneous group, but consists of patients with an early-stage disease and patients with locally advanced disease. This is in contrast with stage I (T1N0 and T2N0), in which the prognosis is more circumscribed (5-year survival: 60 to 70%). Nevertheless, in Europe, surgery without adjuvant therapy seems to be the first choice of treatment in both groups.
In our present study, we reviewed 58 cases with T1N1M0 disease to assess whether survival is influenced by a specific type of lymph node involvement.
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