Non-Small Cell Lung Cancer With N1 Involvement or Skip Metastases Presents the Same Survival Outcome: Results From a...

Area of Science:

• Oncology
• Thoracic Surgery
• Pulmonary Medicine

Background:

• Prognostic differences between non-small cell lung cancer (NSCLC) patients with hilar metastases versus those with mediastinal lymph node (N2) skip metastases remain unclear.
• Understanding these differences is crucial for accurate staging and treatment planning in NSCLC.

Purpose of the Study:

• To investigate whether significant prognostic differences exist between NSCLC patients with hilar metastases (N1) and those with mediastinal N2 skip metastases.
• To compare the overall survival (OS) outcomes of these two patient groups.

Main Methods:

• Retrospective review of data from 480 NSCLC patients (adenocarcinoma/squamous cell carcinoma) across seven high-volume centers (2004-2014).
• Exclusion of patients with non-ADC/SCC histology, incomplete data, neoadjuvant treatment, distant metastases, or incomplete resection.
• Analysis of prognostic factors including T-stage, histology, pathological stage, nodal characteristics, and adjuvant therapy using Kaplan-Meier, log-rank tests, and multivariable Cox regression.

Main Results:

• Five-year overall survival (5YOS) was 53.9% in the analyzed cohort.
• No significant differences in OS were observed between pN1 and pN2 patients or between stage IIB and stage IIIA-B patients.
• Independent negative prognostic factors identified were T-stage ≥3 and age ≥68 years.

Conclusions:

• Patients with N1 involvement (hilar) and those with N2 skip metastases exhibit similar prognoses.
• This finding suggests that N2 involvement in these cases may result from direct lymphatic drainage to mediastinal stations.
• The study implies that current staging may need refinement to better reflect the prognostic implications of nodal involvement patterns in NSCLC.