Unfavorable prognosis of patients with stage II non-small cell lung cancerassociated with macroscopic nodal metastases

Background: Patients midi stage II-NI non-small cell lung cancer (NSCLC) ma ke up an intermediate group of patients with an unsatisfactory prognosis ev en though complete resection is usually possible. We retrospectively analyz ed postoperative prognostic factors to devise guidelines for the proper man agement of this patient population. \ Study design: Among 546 patients with NSCLC who underwent surgical resection from 1979 to 1995, 43 patients were pathologically defined to be at stage II-N1 (T1-2N1M0). The influence of t he following variables on postoperative survival was analyzed: gender, age, cell type, pathologic T factor, number of metastatic nodes, station of met astatic nodes (hilar or pulmonary nodes), status of nodal metastasis (macro scopic, gross involvement confirmed histologically; or microscopic, metasta sis first defined by histologic examination) surgical methods, and adjuvant therapy (including 18 of chemotherapy and 2 of radiotherapy), Results: The 5-year survival rates (5YSRs) of patients with microscopic (n = 21) and macroscopic nodal metastasis (n = 22) were 76.0% and 27.6%, respe ctively (p = 0.001). The 5YSRs of 20 patients who received adjuvant therapy and 23 who did not receive adjuvant therapy were 57.6% and 46.6%, respecti vely (p = 0.036). Other variables did not affect survival. The Cox proporti onal hazards model analysis indicated that the presence of a macroscopic no dal metastasis and postoperative adjuvant therapy were independent prognost ic factors, Among patients with macroscopic N1 NSCLC, 9 patients who had un dergone adjuvant therapy showed a more favorable prognosis than the 13 pati ents who had not received adjuvant therapy (3-year survival rate, 55.6% vs 18.5%; p = 0.037; and recurrence rate, 30.0% vs 77.8%), whereas no signific ant influence of adjuvant therapy on survival was observed among patients w ith microscopic N1 NSCLC. Conclusions: Stage II-NI NSCLC was categorized into microscopic and macrosc opic N1 diseases. The latter had a poor prognosis, which might be improved by adjuvant therapy, although a suitable regimen has not been established.