Overall survival and local recurrence of 406 completely resected stage IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the JapanClinical Oncology Group to plan for clinical trials

Background: the group of completely resected stage IIIA-N2 non-small cell l ung cancer patients (NSCLC) is considered to be heterogenous in various asp ects including survival and the recurrent pattern. In the present study, we attempted to clarify the factors which separate these patients into high a nd low risk groups based on the survival and local recurrence. Methods: a q uestionnaire survey on the survival and local recurrence of non-small cell lung cancer patients with pathological stage IIIA-N2 disease who underwent a complete resection from January 1992 to December 1993 was performed by th e Japan Clinical Oncology Group as of July 1999. The information on the sur vival of 406 patients and that of local recurrence in 332 of them was avail able. Results: the 5-year survival of the 406 patients was 31.0%. In a univ ariate analysis, the age, clinical and pathological T status, number of N2 stations, pathological NI disease, operative modality and postoperative rad iotherapy were all found to be important prognostic factors. Clinical N2 di sease marginally influenced the survival (P=0.07). In a multivariate analys is of these variables including clinical N2 disease, the survival was signi ficantly worse in the case of multiple N2 stations (hazard ratio=1.741), th e presence of pathological NI disease (1.403), pathological T2 or 3 disease (1.399) and an age older than 65 (1.327). The rate of freedom from any loc al recurrence at the bronchial stump, or in the hilar, mediastinal or supra clavicular lymph nodes at 5 years was 64%. In a univariate analysis of the freedom from local recurrence, the clinical N status, pathological T status , pathological N1 disease and number of N2 stations were all found to be im portant prognostic factors. A multivariate analysis revealed the freedom fr om local recurrence to be adversely influenced by multiple N2 stations (haz ard ratio=2.05), and the presence of either clinical N1 or 2 (1.733) diseas e. The 5-year survival and the rate of freedom from local recurrence at 5 y ears were 43 and 75% in patients with a single N2 station and 17 and 48% in those with multiple N2 stations, respectively. Conclusions: the number of N2 stations (single vs. multiple N2 stations) was found to be a useful prog nostic factor, which can separate completely resected stage IIIA-N2 patient s into high and low risk groups regarding both the overall survival and loc al recurrence. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.