FACTORS DETERMINING SURVIVAL IN RESECTED N2 LUNG-CANCER

This retrospective study was based on 237 patients with non-small cell lung cancer (NSCLC) and nodal N2 disease, All accessible mediastinal lymph nodes (LN) were removed and classified according to their anatom ical location in LN chains, The pulmonary resections performed were:pn eumonectomy (n = 187),lobectomy (rt = 44) and segmentectomy (n=4), The re was solitary nodal chain involvement by metastasis in 141 cases, tw o chains in 72 cases and three or more in 24; ''skip'' metastases were present in 26.6%, N2 disease would have been missed in 45 cases of si ngle chain involvement (31.9%) if routine removal of mediastinal nodes had not been performed, The overall 5-year survival rate was 18.8%, S urvival was not influenced by site, size or extension (T) of tumor, tu mor histology or the presence of vascular invasion, The prognosis was significantly worsened by the presence of microscopic residual disease (30 cases) and of satellite nodules (23 cases), Survival was signific antly improved when metastases involved a single LN chain (26.3 versus 8.3%, P = 0.0003), The location and number of involved nodes in the c hain, ''skip'' metastases and the presence of extracapsular spread of carcinoma did not influence the prognosis, Routine mediastinal LN diss ection is necessary to improve survival and for classification of lung cancer, Anatomic description allows better understanding of N2 diseas e which is not a contraindication to surgery when a gross complete res ection can be achieved.