Number Of Metastatic Stations Research Articles

The impacts of isolated N1 lymph nodes metastasis on prognosis in non-small cell lung cancer: A single-center experience.

Background This study aims to investigate long-term results related to N1 group metastases with respect to anatomical localization and many external parameters and to examine the effect of these parameters on prognosis in patients with in nonsmall cell lung cancer. Methods Between January 2006 and May 2019, a total of 52 patients (44 males, 8 females; mean age: 59.9±9.5 years; range, 42 to 80 years) who underwent lobectomy due to primary lung malignancy were retrospectively analyzed. The N1 lymph nodes were divided into three anatomical groups as hilar, peribronchial, and intraparenchymal. Demographic features, tumor features, follow-up characteristics, and survival and diseasefree survival parameters were analyzed for each group. The results were also examined in terms of number of metastasis, number of metastatic levels, rate of metastasis, and histopathological type. Results The five-year survival rate was 66.4% in the peribronchial group and 50% in the hilar group. The five-year disease-free survival rate was 45.7% in the peribronchial group and 37.5% in the hilar group. There was no statistically significant difference between the groups in terms of survival and disease-free survival for anatomical localization, number of metastasis, number of metastatic levels, rate of metastasis, and histopathological type (p>0.05 for all). Conclusion The structure that would be formed by examining N1 in terms of parameters such as subtitle levels, number of metastasis, number of metastatic stations, rate of metastasis or combinations of these would have a more impact on the decisions in the follow-up and treatment process in this patient population.

Prognostic Impact of Node-Spreading Pattern in Surgically Treated Small-Cell Lung Cancer: A Multicentric Analysis.

Although surgery in selected small-cell lung cancer (SCLC) patients has been proposed as a part of multimodality therapy, so far, the prognostic impact of node-spreading pattern has not been fully elucidated. To investigate this issue, a retrospective analysis was performed. From 01/1996 to 12/2012, clinico-pathological, surgical, and oncological features were retrospectively reviewed in a multicentric cohort of 154 surgically treated SCLC patients. A multivariate Cox proportional hazard model was developed using stepwise regression, in order to identify independent outcome predictors. Overall (OS), cancer-specific (CSS), and Relapse-free survival (RFS) were calculated by Kaplan-Meier method. Overall, median OS, CSS, and RFS were 29 (95% CI 18-39), 48 (95% CI 19-78), and 22 (95% CI 17-27) months, respectively. Lymphadenectomy was performed in 140 (90.9%) patients (median number of harvested nodes: 11.5). Sixty-seven (47.9%) pN0-cases experienced the best long-term survival (CSS: 71, RFS: 62months; p<0.0001). Among node-positive patients, no prognostic differences were found between pN1 and pN2 involvement (CSS: 22 vs. 15, and RFS: 14 vs. 10months, respectively; p=0.99). By splitting node-positive SCLC according to concurrent N1-invasion, N0N2-patients showed a worse CSS compared to those cases with combined N1N2-involvement (N0N2: 8months vs. N1N2: 22months; p=0.04). On the other hand, the number of metastatic stations (p=0.80) and the specific node-level (p=0.85) did not affect CSS. At multivariate analysis, pN+ (HR: 3.05, 95% CI 1.21-7.67, p=0.02) and ratio between metastatic and resected lymph-nodes (RL, HR: 1.02, 95% CI 1.00-1.04, p=0.03) were independent predictors of CSS. Moreover, node-positive patients (HR: 3.60, 95% CI 1.95-6.63, p<0.0001) with tumor size ≥5cm (HR: 1.85, 95% CI 0.88-3.88, p=0.10) experienced a worse RFS. In selected surgically treated SCLC, the long-term survival may be stratified according to the node-spreading pattern.

Prognostic factors after surgical resection of N1 non-small cell lung cancer

ObjectivesNon-small cell lung carcinoma (NSCLC) with N1 involvement is associated with 5-year survival rates ranging from 7% to 55%. Numerous factors have been independently reported to explain this heterogeneous prognosis, but their relative weight on long-term survival is unknown. MethodsPatients who underwent surgical resection for NSCLC in two French centers from 1993 to 2010 were prospectively recorded and retrospectively reviewed. The overall survival (OS) of patients undergoing first-line surgery for pN1 disease was analyzed according to the type of extension, number of metastatic LN, number and anatomic location of metastatic stations. ResultsThe study group included 450 patients (male 80.2%, mean age 63.3 ± 9.9 years, 5-year overall survival 46%). The number of metastatic station was 1 in 340 (75.6%, single-station disease) and ≥2 in 110 patients (24.4%, multi-station disease). The number of metastatic stations was correlated with the number of metastatic LN (p < .001), and associated with adverse OS (p = .0014). The presence of intralobar metastatic LN (station 12–13–14) was associated with a mechanism of direct extension (p < .001), but did not impact OS (p = .71). The location of metastatic stations was of prognostic significance only in case of multi-station disease, with hilar (station 10) involvement being associated with adverse OS (p = .005). The 110 patients with multi-station pN1 disease and the 134 patients operated on for single-station pN0N2 (skip-N2) disease during the study period yield comparable outcome (p = .52). ConclusionsIn patients with resected pN1 NSCLC, the number of metastatic stations and their location in case of multi-station disease have a prognostic value.

Impact of insulin-like growth factor 2 expression on prognosis of lung adenocarcinoma with mediastnal lymphnode metastasis

Objective:Insulin-like growth factor 2 had a high expression in many cancers.In the current paper,the expression of Insulin-like growth factor 2 was investigated and its prognostic significance in lung adenocarcinoma with mediastinal lymph node metastasis was studied.Methods:A retrospective immunohistological analysis of specimens of lung adenocarcinoma with mediastinal lymphnode metastasis was conducted.All patients did not have neoadjuvant chemotherapy and/or radiotherapy.The prognostic factors of stage N_2 lung adenocarcinoma and the impact of insulin-like growth factor 2 on the prognosis of patients with stage N_2 lung adenocarcinoma were also studied.Results:Factors including T stage,station 7 metastasis,and the number of metastatic stations had an impact on the prognosis of stage N2 lung adenocarcinoma.The 5-year overall survival of patients with negative and positive expression of insulin-like growth factor 2 were 18%and 8%,respectively(P= 0.034 ).Conclusion:The prognosis of stage N_2 lung adenocarcinoma is poor.The prognostic factors of stage N_2 lung adenocarcinoma include the T stage,station 7 metastasis,the number of metastatic stations,and the expression of insulin-like growth factor 2.

Clinicopathological Factors Associated with Unexpected N3 in Patients with Mediastinal Lymph Node Involvement

We have already shown that postoperative survival was poor in p-N3 patients from the experience of extended radical nodal dissection (ERD: cervical and bilateral mediastinal nodal dissection) for lung cancer. In this retrospective study, we aimed to clarify the clinicopathological factors associated with p-N3 in patients with mediastinal lymph node involvement (excluding c-N3) who underwent ERD, and we studied their impact on prognosis. Between 1996 and April 2006, in patients with lung cancer in the right upper lobe, we performed ERD after obtaining informed consent from the patients. The study comprised 8 females and 29 males (median age of 60 years), with 15/7/15 cases of c-N0/c-N1/c-N2, respectively. The clinicopathological records of each patient were examined for prognostic factors associated with p-N3, including age, gender, histology, c-N number, preoperative serum CEA level, number of metastatic stations, and distribution of metastatic nodes according to the system of Naruke et al. Because c-N3 cases were excluded from the study, we defined p-N3 as unexpected N3. Of the 37 study subjects, 19 (51.4%) had one or more metastases to the mediastinal lymph nodes. Of these 19 patients, 10 (52.6%) had metastases to cervical and/or contralateral mediastinal lymph nodes (unexpected N3; 5-year survival was 0%). C-N factor (c-N2), nonskip N2, multistation mediastinal lymph node metastasis, highest mediastinal nodal involvement, and pT status were significantly associated with unexpected N3. In particular, multistation mediastinal lymph node metastasis and highest mediastinal nodal involvement were significant prognostic factors in multivariate analyses. Because unexpected N3 patients showed a poor prognosis after ERD, treatment modalities other than surgery should be considered. On the other hand, because true N2 patients showed a good outcome after surgery, surgical resection may be considered an important therapeutic modality even for N2 patients, given that they show single-station mediastinal nodal involvement or c-N0-1.

Prognostic Significance of Metastasis to the Highest Mediastinal Lymph Node in Nonsmall Cell Lung Cancer

We have tried to clarify the prognostic significance of metastasis to the highest mediastinal (HM) lymph node in patients with N2 lung cancer who underwent complete dissection of superior mediastinal (including HM) lymph nodes. This study analyzed 53 patients with N2 nonsmall cell lung cancer who underwent surgical procedures such as lobectomy plus hilar and mediastinal node dissection (T4, neoadjuvant therapy cases were excluded). For patients whose cancer was in the left lung, we performed surgery through the median sternotomy in order to dissect superior mediastinal nodes. The clinicopathologic records of the patients were examined for prognostic factors such as age, sex, side, histology, tumor location, tumor size, clinical node (cN) number, preoperative serum carcinoembryonic antigen level, number of metastatic stations, and HM lymph node involvement. A univariate analysis showed that tumor size (T1/T2-3), cN factor (cN1-2/cN0), N2 level (multiple/single), and metastasis to the HM node were significant prognostic factors. In the multivariate analysis, metastasis to the HM lymph node remained a significant prognostic factor (p = 0.026). The 3-year survival rates were 52% in patients without metastasis to the HM lymph node and 21% in patients with metastasis to the HM lymph node (p < 0.001). Furthermore, when HM nodal involvement was absent, the 5-year survival rate was 33% even in patients with multilevel N2 status, 45% in patients with cN1-2 status, and 47% in patients with pT2-3 tumor status. Highest mediastinal lymph node involvement is prognostic of highly advanced N2 disease resulting in poor outcome. The results also suggest that patients with no involvement of the HM lymph node can experience acceptable postoperative outcomes even if they have multilevel N2 status, positive cN status, or T2-3 tumor status.