SURVIVAL AND PROGNOSTIC FACTORS IN RESECTED N2 NONSMALL CELL LUNG-CANCER - A STUDY OF 140 CASES

Background. The selection of stage IIIA N2 non-small cell lung cancer patients for primary surgical treatment remains controversial. Methods . One hundred forty patients with resected non-small cell lung cancer who eventually proved to have pathologic N2 disease were studied with a univariate and multivariate analysis of prognostic factors. Results. Nineteen patients had a positive mediastinoscopy; the others had a pr eoperative N0 or N1 stage. Complete resection rate was 80.7%. Five-yea r survival was 20.8% (95% confidence interval, 17.2% to 24.4%), 32.2% in mediastinoscopy-negative patients. In the univariate analysis, clin ical N stage at mediastinoscopy, complete resection, performance statu s, T stage, number of metastatic levels in adenocarcinoma, and nodal c apsule rupture were important factors. In a multivariate model, surviv al was worse in case of higher T stage (relative risk = 1.43), lower p erformance status (relative risk = 1.37), involvement of more than one node level (relative risk = 1.68), nonsquamous histology (relative ri sk = 1.29) and clinical N2 stage (relative risk = 1.43). Long-term sur vival was unlikely when lactic dehydrogenase or carcinoembryonic antig en levels were elevated. Conclusions. In clinical N0 or N1 cancer, com plete resection resulted in reasonable survival prospects. In patients with N2 disease discovered at mediastinoscopy, surgical treatment was only worthwhile in case of minimal N2. Several unfavorable prognostic factors could be identified in the univariate analysis and confirmed in a multivariate Cox model. (C) 1997 by The Society of Thoracic Surge ons.