Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival?

Objective: We analyzed the effect of the station of mediastinal metastasis with regard to the location of the primary tumor on the prognosis in patien ts with non-small cell lung cancer. Methods: Of 956 consecutive patients wh o underwent operation for primary lung carcinoma between 1986 and 1996, 760 patients (79.5%) were diagnosed as having nonsmall cell carcinoma and were subjected to complete removal of hilar and mediastinal lymph nodes togethe r with the primary tumor. Results: The status of lymph node involvement was NO in 480 patients (63.2%), N1 in 139 patients (18.3%), and N2 in 141 pati ents (18.6%), The 5- and 10-year survival of patients with N2 disease were 26% and 17%, respectively. Neither cell type nor the extent of procedure wa s a significant survival determinant. Patients having involvement of subcar inal nodes from upper-lobe tumors had a significantly worse prognosis than those patients with metastases only to the upper mediastinal or aortic node s (P = .003). Patients with nodal involvement of the upper mediastinum from lower-lobe tumors had a significantly worse survival than those patients w ith metastases limited to the lower mediastinum (P = .039), Furthermore, pa tients,vith involvement of the aortic nodes alone from left upper-lobe tumo rs had a significantly better survival than those patients with metastasis to the upper or lower mediastinum beyond the aortic region (P = .044). Conc lusions: When mediastinal metastasis is limited to upper nodes from upper-l obe tumor, to lower nodes from lower-lobe tumor, or to aortic nodes from le ft upper-lobe tumor, acceptable survival could be expected after radical re section.