Current outcome in patients with lung cancer and positive mediastinoscopy

A retrospective study was undertaken to determine the contemporary treatment and outcome of patients with lung cancer and positive lymph nodes proven at mediastinoscopy.

From 1994 to 1999 a cervical mediastinoscopy was performed in 361 patients. Metastatic lymph nodes from a bronchogenic carcinoma were present in 81 patients; 71 were men. Mean age was 61.7 years. Squamous cell carcinoma and adenocarcinoma were present in 26 patients each (32.1%), large cell carcinoma in 19 patients (23.4%), small cell carcinoma in six patients (7.4%) and other histologies in four patients (5%). Stage IIIA was found in 51 patients (69.9%), IIIB in 17 (23.3%) and IV in 5 (6.8%). Of eight patients no precise stage could be determined (9.9%). These patients were retrospectively reviewed. Survival time was analyzed according to the Kaplan-Meier method. A multivariate Cox analysis was performed to determine significant factors in relation to survival.

Forty-four patients (54.3%) were treated by induction chemotherapy, of which 15 were operated on, 11 patients (13.6%) had chemotherapy only, 11 (13.6%) radiotherapy only, 3 (3.7%) combined chemo- and radiotherapy, 1 patient (1.2%) had an operation only, and 11 (13.6%) received palliative treatment. Follow-up was complete; 16 patients (19.8%) are alive and 65 (80.2%) died, mostly of local recurrence and metastases. Median survival time (MST) for all 81 patients was 12 months [95% confidence interval (CI) 10-14 months.]. MST for the 15 patients treated by induction chemotherapy + surgery was 27 months [95% CI 18-36 months] and for the 15 patients treated by induction chemotherapy + radiotherapy 15 months [95% CI 12-18 months]. The difference between these two subgroups was significant (p = 0.03). For the 11 patients who had palliative treatment MST was 6 months [95% CI 4-8 months]. The other subgroups had a MST of 10 months or less. In a multivariate Cox analysis only specific treatment (p = 0.0002) and stage (p = 0.02) were found to be significant.

Outcome of patients with lung cancer and positive mediastinoscopy remains poor. In this retrospective study best results were obtained by induction chemotherapy + surgery. An effort should be made to include as many of these patients as possible in neoadjuvant trials.