Original articleGeneral thoracicThe Significance of One-Station N2 Disease in the Prognosis of Patients With Nonsmall-Cell Lung Cancer
Section snippets
Material and Methods
From January 1993 to December 2004, 1,329 patients underwent lung resection for bronchogenic carcinoma pathologically staged as pI–IIIA. The Scientific and Ethics Committee of Sismanogleio General Hospital has approved the conduction of the study. Individual consent for the study was waived.
This group included 1,077 men (81%) and 252 women (19%), aged 44 tp 78 years (median, 62). The types of resection included 372 pneumonectomies (27.9%), 219 right (59%) and 153 left (41%), and 957 lobectomies
Results
Patients at stage pIIIA/N2 were the target group to be studied. This group consisted of 302 patients (22.7%). The demographic and clinicopathologic characteristics of this group are fully described in Table 1.
The incidence of mediastinal lymph node involvement according to primary tumor location was studied (Table 2). In 59% of the cases, the upper mediastinal lymph nodes were invaded, 22.5% of the lower ones and 18.5% of both the upper and lower lymph node stations. Positive lymph nodes
Comment
One should not take for granted that cancer lymphatic spread follows a linear model from intraparenchymal nodes to hilar, mediastinal, and extrathoracic ones. The lymphatic network draining the lung is extensive and variability is probably the rule. Riquet and colleagues [11] have reported direct lymph passages from each lobe to the mediastinum. More commonly, these communications were observed in the upper lobes. This provides multiple pathways for dissemination, creating a complicated model
References (33)
- et al.
Mediastinal spread of metastatic lymph nodes in bronchogenic carcinoma
Chest
(1990) - et al.
Patterns of mediastinal metastases in bronchogenic carcinoma
Chest
(1986) - et al.
Distribution and likelihood of lymph node metastasis based on the lobar location of non-small cell lung cancer
Ann Thorac Surg
(2006) - et al.
Involvement of lymphatic metastatic spread in non-small cell lung cancer accordingly to the primary cancer location
Lung Cancer
(2004) Revision of the international system for staging lung cancer
Chest
(1997)- et al.
Regional lymph node classification for lung cancer staging
Chest
(1997) - et al.
Mediastinal lymph node metastasis in patients with clinical stage I peripheral non-small cell lung cancer
J Thorac Cardiovasc Surg
(1997) - et al.
Results of surgical intervention for p-stage III(N2) non-small cell lung cancer: acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in upper lobe
J Thorac Cardiovasc Surg
(2004) - et al.
Direct lymphatic drainage of lung segments to the mediastinal nodes
J Thorac Cardiovasc Surg
(1989) - et al.
Skip metastasis to the mediastinal lymph nodes in non-small cell lung cancer
Ann Thorac Surg
(1996)