LONG-TERM SURVIVORS WITH PN2 NONSMALL CELL LUNG-CANCER AFTER A COMPLETE RESECTION WITH A SYSTEMATIC MEDIASTINAL NODE DISSECTION

Objective: A substantial number of surgical patients with pN2 disease have survived longer than 5 years without any evidence of recurrence, although the surgical indications for those patients remain controvers ial. The present study was performed in order to clarify the clinical characteristics of the long-term survivors with pN2 disease. Methods: We retrospectively reviewed the cases of 111 patients with pN2 disease who had undergone a complete resection with a systematic mediastinal lymph node dissection from 1974 through 1991. Results: Of the ill pati ents with pN2 disease, 20 survived longer than 5 years after a surgica l resection. When both the pre- and postoperative conditions were comp ared between the long-term survivors and the others, the long-term sur vivors were characterized by significantly higher proportions of cNO d isease (P = 0.031), pT1 disease (P = 0.004), skip metastasis without h ilar node metastasis (P = 0.028), and metastasis of a single mediastin al station (0.044). Of those characteristics, only the likelihood of h aving cNO disease could be pre-operatively determined. The survival ra te of such a population with cN0-pN2 disease was 34.5% at 5 years and 29.6% at 10 years after a complete resection, respectively. Conclusion s: Pathologic N2 patients with some favorable prognostic factors can s urvive long-term after a complete resection combined with a systematic mediastinal lymph node dissection At present, due to the lack of any effective adjuvant therapy, a systematic mediastinal node dissection s hould be routinely performed even in patients with cNO disease. (C) 19 98 Elsevier Science B.V. All rights reserved.