• Changhoon Yoo, Shinkyo Yoon, Dae Ho Lee, Seung-Il Park, Dong Kwan Kim, Yong-Hee Kim, KimHyeong RyulHRDepartment of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea., Se Hoon Choi, Woo Sung Kim, Chang-Min Choi, Se Jin Jang, Si Yeol Song, Su Ssan Kim, Eun Kyung Choi, Jae Cheol Lee, Cheolwon Suh, Jung-Shin Lee, and Sang-We Kim.
• Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
• Clin Lung Cancer. 2015 Nov 1; 16 (6): e203-12.

UnlabelledStage IIIA-N2 non-small cell lung cancer (NSCLC) shows prognostic heterogeneity. We investigated the prognostic relevance of the number of metastatic pN2 nodes in patients with IIIA-N2 NSCLC. The criteria for the number of pN2 used in this study were significantly associated with the survival outcomes after surgery and may improve the accuracy of prognostic prediction in this subgroup of patients.IntroductionThere have been controversies regarding the prognostic relevance of the number of positive N2 nodes in pathologic stage IIIA-N2 non-small-cell lung cancer (NSCLC). We examine prognosis of patients with pathologic stage IIIA-N2 with classifying the number of positive N2 nodes into subgroups.MethodsFrom January 1997 to December 2004, 250 patients were diagnosed with pathologic stage IIIA-N2 disease. All patients underwent mediastinal lymph node dissection. After excluding 44 patients with preoperative chemotherapy, incomplete resection, and postsurgical mortality, 206 patients were included in the analysis. Patients were classified according to the number of positive N2 lymph nodes (N2a: 1 [n = 83], N2b: 2-4 [n = 82], N2c: ≥ 5 [n = 41]), and its correlation with survival outcomes were investigated.ResultsWith a median follow-up of 96.3 months, 5-year disease-free survival (DFS) was 27.2% (95% confidence interval [CI], 21.6-33.7), and 5-year overall survival (OS) was 37.7% (95% CI, 31.5-44.7) in all patients. The number of metastatic N2 lymph nodes was associated with DFS (P < .001) and OS (P = .01). In the N2a, N2b, and N2c groups, 5-year DFS rates were 38%, 24%, and 5%, respectively, and 5-year OS rates were 47%, 35%, and 24%, respectively. In a multivariate analysis, the number of metastatic N2 lymph nodes was an independent prognostic factor for DFS and OS.ConclusionStratification of patients according to the number of metastatic N2 lymph nodes may improve the accuracy of prognostic prediction among patients with curatively resected stage IIIA-N2 NSCLC.Copyright © 2015 Elsevier Inc. All rights reserved.

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