LYMPH-NODE TYPE AS A PROGNOSTIC FACTOR FOR SURVIVAL IN T2 N1 M0 NONSMALL CELL LUNG-CARCINOMA

Background. Patients with stage II non-small cell lung carcinoma repre sent a group with varying 5-year survival rates. The influence of spec ific types of lymph node involvement on survival was investigated. Met hods. Of 2,009 patients operated on from 1977 through 1993, the cases of 391 patients with pathologic T2 N1 M0 disease were reviewed. The N1 status was refined into lymph node involvement by direct extension or by metastases in lobar or hilar lymph nodes. Results. The cumulative 5-year survival rate of all hospital survivors (n = 369) was 37.8%. Th e 5-year survival rate of patients with lobar metastases was superior to that of patients with hilar metastases (57.3% versus 30.3%; p = 0.0 028) and that of patients with lymph node involvement by direct extens ion (57.3% versus 39.1%; p = 0.03). The survival rate did not differ b etween those with hilar metastases and those with direct extension. Su rvival was significantly poorer in patients with visceral pleural invo lvement, in patients with adenocarcinoma, and in patients older than 6 0 years. Survival was not related to sex, type of resection, central g rowth, or tumor size. Conclusions. Survival differs according to the t ype of lymph node involvement: lobar lymph node metastasis seems to be an early stage of the disease, whereas hilar lymph node metastasis re presents a more advanced form. However, in T2 N1 M0 disease, other fac tors besides nodal status also seem to play an important role in posto perative survival. (C) 1997 by The Society of Thoracic Surgeons.