The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 849-858 , October 2009

Is there a subset of patients with preoperatively diagnosed N2 non–small cell lung cancer who might benefit from surgical resection?

  • Giovanni B. Ratto, MD

      Affiliations

    • Unit of Thoracic Surgery, Department of Surgical Oncology, National Cancer Research Institute, Genoa, Italy
    • Corresponding Author InformationAddress for reprints: Giovanni B. Ratto, MD, Unit Thoracic Surgery, Department Surgical Oncology, National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
    • ,
  • Roberta Costa, MD

      Affiliations

    • Department of Cardiothoracic Surgery, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
    • ,
  • Paola Maineri, MD

      Affiliations

    • Unit of Thoracic Surgery, Department of Surgical Oncology, National Cancer Research Institute, Genoa, Italy
    • ,
  • Antonella Alloisio, MD

      Affiliations

    • Unit of Thoracic Surgery, Department of Surgical Oncology, National Cancer Research Institute, Genoa, Italy
    • ,
  • Paolo Bruzzi, MD

      Affiliations

    • Unit of Clinical Epidemiology, Department of Epidemiology and Prevention, National Cancer Research Institute, Genoa, Italy
    • ,
  • Beatrice Dozin, PhD

      Affiliations

    • Unit of Clinical Epidemiology, Department of Epidemiology and Prevention, National Cancer Research Institute, Genoa, Italy

Received 18 August 2008 ,Revised 6 February 2009 ,Accepted 8 March 2009.

References 

  1. Andre F, Grunenwald D, Pignon JP, Dujon A, Pujol JL, Brichon PY, et al. Survival of patients with resected N2-NSCLC: evidence for a subclassification and implications. J Clin Oncol. 2000;18:2981–2989
  2. Robinson LA, Ruckdeschel JC, Wagner H, Stevens CW. American College of Chest Physicians. Treatment of non–small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):243S–265S
  3. Albain KS, Swann RS, Rusch VR. Phase III study of concurrent chemotherapy and radiotherapy (CT/RT) vs CT/RT followed by surgical resection for stage IIIA (pN2) non-small-cell lung cancer (NSCLC): outcomes update of North American Intergroup 0139 (RTOG 9309). [abstract] Proc Am Soc Clin Oncol. 2005;23(suppl):7014;Abstract 7014
  4. van Meerbeeck JP, Kramer GW, Van Schil PE, Legrand C, Smit EF, Schramel F, et al. European Organisation for Research and Treatment of Cancer-Lung Cancer Group Randomized control trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer. J Natl Cancer Inst. 2007;99:442–450
  5. Watanabe Y, Shimizu J, Oda M, Hayashi Y, Watanabe S, Tatsuzawa Y, et al. Aggressive surgical intervention in N2 non–small cell cancer of the lung. Ann Thorac Surg. 1991;51:253–261
  6. Goldstraw P, Mannam G, Kaplan D, Michail P. Surgical management of non-small-cell cancer with ipsilateral mediastinal node metastasis (N2 disease). J Thorac Cardiovasc Surg. 1994;107:19–28
  7. Ratto GB, Mereu C, Motta G. The prognostic significance of preoperative assessment of mediastinal lymph nodes in patients with lung cancer. Chest. 1988;93:807–813
  8. Shields TW. The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non–small cell carcinoma of the lung. J Thorac Cardiovasc Surg. 1990;99:48–53
  9. Pearson F, DeLarue N, Ilves R, Todd TR, Cooper JD. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg. 1982;83:1–11
  10. Goldstraw P. The practice of cardiothoracic surgeons in the perioperative staging on non–small cell lung cancer. Thorax. 1992;47:1–3
  11. Pearson FG. Mediastinal adenopathy—the N2 lesion. In:  DeLarue NC,  Eschapasse H editor. International trends in general thoracic surgery, vol. 1. Lung cancer. Philadelphia: WB Saunders; 1985;p. 104
  12. Backer CL, Shields TW, Lockhart CG, Vogelzang R, LoCicero J. Selective preoperative evaluation for possible N2 disease in carcinoma of the lung. J Thorac Cardiovasc Surg. 1987;93:337–343
  13. Martini N, Flehinger BJ. The role of surgery in N2 lung cancer. Surg Clin North Am. 1987;67:1037–1049
  14. Suzuki K, Nagai K, Yoshida J. The prognosis of surgically resected N2 non–small cell lung cancer: the importance of clinical N status. J Thorac Cardiovasc Surg. 1999;118:145–153
  15. Ruckdeshel JC. Combined modalities therapy of non–small cell lung cancer. Semin Oncol. 1997;24:429–439
  16. Vansteenkiste JF, De Leyn PR, Deneffe GJ, Stalpaert G, Nackaerts KL, Lerut TE, et al. Survival and prognostic factors in resected N2 non–small cell lung cancer: a study of 140 cases. Leuven Lung Cancer Group. Ann Thorac Surg. 1997;63:1441–1450
  17. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Induction therapy for non–small cell lung cancer with involved mediastinal nodes in multiple stations. Chest. 2000;118:123–128
  18. Ichinose Y, Kato H, Koike T, Tsuchiya R, Fujisawa T, Shimizu N, et al. Overall survival and local recurrence of 406 completely resected stage IIIa-N2 non–small cell lung cancer patients: questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials. Lung Cancer. 2001;34:29–36
  19. Keller SM, Adak S, Wagner H, Johnson DH. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non–small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg. 2000;70:358–366
  20. Prenzel KL, Baldus SE, Mönig SP, Tack D, Sinning JM, Gutschow CA, et al. Skip metastasis in nonsmall cell lung carcinoma: predictive markers and isolated tumor cells in N1 lymph nodes. Cancer. 2004;100:1909–1917
  21. Naruke T, Suemasu K, Ishikawa K. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg. 1978;76:832–839
  22. Sawyer TE, Bonner JA, Gould PM. The impact of surgical adjuvant thoracic radiation therapy for patients with non–small cell lung carcinoma with ipsilateral mediastinal lymph node involvement. Cancer. 1997;80:1399–1408
  23. Mountain CF. The biological operability of stage III non–small cell lung cancer. Ann Thorac Surg. 1985;40:60–64
  24. Vansteenkiste JF, De Leyn PR, Deneffe GJ, Lerut TE, Demedts MG. Clinical prognostic factors in surgically treated stage IIIA N2 non–small cell lung cancer: analysis of the literature. Lung Cancer. 1998;19:3–13
  25. Sioris T, Järvenpää R, Kuukasjärvi P, Helin H, Saarelainen S, Tarkka M. Comparison of computed tomography and systematic lymph node dissection in determining TNM and stage in non–small cell lung cancer. Eur J Cardiothorac Surg. 2003;23:403–408
  26. Roth JA, Fossella F, Komaki R, Ryan MB, Putnam JB, Lee JS, et al. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non–small cell lung cancer. J Natl Cancer Inst. 1994;86:673–680
  27. Rosell R, Gómez-Codina J, Camps C, Maestre J, Padille J, Cantó A, et al. A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non–small cell lung cancer. N Engl J Med. 1994;330:153–158
  28. Depierre A, Milleron B, Moro-Sibilot D, Chevret S, Quoix E, Lebeau B, et al. Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and IIIA non–small cell lung cancer. J Clin Oncol. 2002;20:247–253
  29. Nagai K, Tsuchiya R, Mori T, Tada H, Ichinose Y, Koike T, et al. A randomized trial comparing induction chemotherapy followed by surgery with surgery alone for patients with stage IIIA N2 non–small cell lung cancer (JCOG 9209). J Thorac Cardiovasc Surg. 2000;125:254–260
  30. Pass HI, Pogrebniak HW, Steinberg SM, Mulshine J, Minna J. Randomized trial of neoadjuvant therapy for lung cancer: interim analysis. Ann Thorac Surg. 1992;53:992–998
  31. Bueno R, Richards WG, Swanson SJ, Jaklitsch MT, Lukanich JM, Mentzer SJ, et al. Nodal stage after neoadjuvant therapy for stage IIIA lung cancer determines patient survival. Ann Thorac Surg. 2000;70:1826–1831
  32. Voltolini L, Luzzi L, Ghiribelli C, Paladini P, Di Bisceglie M, Gotti G. Results of induction chemotherapy followed by surgical resection in patients with stage IIIA (N2) non–small cell lung cancer: the importance of the nodal down-staging after chemotherapy. Eur J Cardiothorac Surg. 2001;20:1106–1112
  33. Betticher DC, Hsu Schmitz SF, Tötsch M, Hansen E, Joss C, von Briel C, et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial. J Clin Oncol. 2003;21:1752–1759
  34. Albain KS, Rusch VW, Crowley JJ, Rice TW, Turrisi AT, Weick JK, et al. Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small-cell lung cancer: mature results of Southwest Oncology Group phase II study 8805. J Clin Oncol. 1995;13:1880–1892
  35. Sawabata N, Keller SM, Matsumura A, Kawashima O, Hirono T, Osaka Y, et al. The impact of residual multi-level N2 disease after induction therapy for non–small cell lung cancer. Lung Cancer. 2003;42:69–77
  36. De Leyn P, Stroobants S, De Wever W, et al. Prospective comparative study of integrated positron emission tomography–computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 non-small-cell lung cancer: a Leuven Lung Cancer Group Study. J Clin Oncol. 2006;24:3333–3339

PII: S0022-5223(09)00419-X

doi: 10.1016/j.jtcvs.2009.03.017

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 849-858 , October 2009

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