TIME TRENDS AND SURVIVAL AFTER SURGERY FOR P-STAGE IIIA, PN2 NONSMALLCELL LUNG-CANCER (NSCLC)

Objective: To evaluate the role of surgery for p-stage IIIa, pN2 non-s mall cell lung cancer (NSCLC), time trends and survival after surgery and the prognostic factors were investigated retrospectively. Methods: Consecutive patients, 155, with p-stage IIIa, pN2 NSCLC who underwent thoracotomy at the Department of Thoracic Surgery. Chest Disease Rese arch Institute, Kyoto University between January 1976 and December 199 0 were divided into three groups by the period of operation (the earli er period: 1976-1980, n = 49: the middle period: 1981-1955, n = 55: an ti the later period: 1956-1990, n = 51), and were reviewed. Of the 15 patients, 84 (54.2%) were preoperatively; evaluated to have medinstina l lymph nodes metastases (cN2 disease). Results: The 5 year survival r ates in the earlier, middle and later periods were 12.1, 18.6, and 43. 8%, respectively. showing significant improvement in the later period (P < 0.001, for the later period versus the earlier period or the midd le period). The improvement was caused by decrease in the rate of oper ation-related death (4.1, 1.8, and 0.0%. in the earlier, the middle, a nd the later period, respectively), increase in the rate of complete t umor resection (59.1, 76.4, and 96.1%, respectively), and decrease in the ratio of pT3N2MO patients (44.9, 34.5, and 17.6%, respectively) ha ving poor prognosis compared with pT1-2N2MO patients, Decrease in the ratio of cT3N2MO patients and for increase in the rate of complete res ection could be realized by accurate preoperative diagnosis with intro duction of chest computed tomography (CT). Based on the preoperative e valuation, the 5 year survival rates of cT1N2MO, cT3N2MO, and cT3N2MO patients were 39.1, 30.5, and 10.2%, respectively, showing significant pour prognosis in cT3N2MO patients. Conclusion: in cT1-2N2MO or pT1-2 N2MO patients, a good prognosis can be realized by complete tumor rese ction with mediastinal lymph nodes dissection. In contrast, surgical t reatment should not be justified in cT3N2MO or pT3N2MO patients. (C) 1 997 Elsevier Science B.V.