Schlachtenberger, Georg ORCID: 0000-0001-7118-8432, Doerr, Fabian, Menghesha, Hruy, Heldwein, Matthias B., Hagmeyer, Lars, Michel, Maximilian, Schaefer, Stephan C., Wahlers, Thorsten and Hekmat, Khosro (2021). Postoperative long-term survival of non-small cell lung cancer patients with skip-N2 metastases. Surg. Oncol.-Oxf., 38. OXFORD: ELSEVIER SCI LTD. ISSN 1879-3320

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Abstract

Objective: Radical lymphadenectomy is crucial in operations for non-small cell lung cancer (NSCLC). Usually pN1 and pN2 lymph nodes are affected consecutively (N1N2). Nevertheless, pN2 metastases may also occur in the absence of pN1 as skip-N2 metastases (N0N2). Here we compare the long-term survival of N1N2- and N0N2 patients. Materials and methods: 464 patients underwent surgery for NSCLC at our institution between 2012 and 2017. We retrospectively reviewed data of pN2 stage patients (n = 68). Patients with N1N2 (n = 39) were compared to N0N2 (n = 29) patients. 1-, 3-and 5-year survival rates were measured. Survival was assessed by Kaplan-Meier curves and the cox proportional hazards model was used to identify prognostic factors for overall survival. All patients received adjuvant chemoradiation therapy according to European guidelines. Results: The baseline characteristics did not differ between groups. We observed no differences in the histology, localization, or gender in our cohort. N0N2 patients showed significantly better 1- (N1N2: 82.4% vs. N0N2 100%; p = 0.001), 3- (14.7% vs. 63.6%; p=<0.001) and 5-year (9.4% vs. 43.8%; p = 0.001) survival rates. Tumor size (Hazard ratio (HR) 1.46, Confidence interval (CI 95%) 1.03-2.04; p = 0.03) and the occurrence of N1N2 (HR 4.26, CI 2.04-8.91; p < 0.0001) were independent prognostic factors for worse long-term survival. The Kaplan-Meier curves showed a reduced overall survival for N1N2 patients (log-rank N1N2, N0N2 p < 0.0001). Conclusion: N1N2 patients have a significantly worse prognosis compared to N0N2 patients. This will aid to classify the heterogeneous pN2-NSCLC patient population more precisely. Further, multimodal therapy should be considered for N1N2 patients.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Schlachtenberger, GeorgUNSPECIFIEDorcid.org/0000-0001-7118-8432UNSPECIFIED
Doerr, FabianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Menghesha, HruyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heldwein, Matthias B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hagmeyer, LarsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Michel, MaximilianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schaefer, Stephan C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wahlers, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hekmat, KhosroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-575944
DOI: 10.1016/j.suronc.2020.11.019
Journal or Publication Title: Surg. Oncol.-Oxf.
Volume: 38
Date: 2021
Publisher: ELSEVIER SCI LTD
Place of Publication: OXFORD
ISSN: 1879-3320
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
LYMPH-NODE METASTASIS; ESTS GUIDELINES; N2 METASTASES; OPEN-LABEL; CHEMOTHERAPY; RESECTIONMultiple languages
Oncology; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/57594

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