Impact of different mediastinal lymphadenectomy on clinical-stage IA non-small cell lung cancer.
- Author:
Kai MA
1
;
Tian-You WANG
;
Bao-Liang HE
;
Dong CHANG
;
Min GONG
Author Information
- Publication Type:Journal Article
- MeSH: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; pathology; surgery; Female; Follow-Up Studies; Humans; Lung Neoplasms; pathology; surgery; Lymph Node Excision; methods; Lymphatic Metastasis; Male; Mediastinum; surgery; Middle Aged; Neoplasm Staging; Prognosis; Retrospective Studies
- From: Chinese Journal of Surgery 2008;46(9):670-673
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVETo study the role of different lymphadenectomy in the treatment of selected clinical-stage IA non-small cell lung cancer.
METHODSAll 115 postoperative patients admitted from January 1997 to May 2002 with pathologic-stage T1 who had been preoperatively diagnosed as clinical-stage I A non-small cell lung cancer were divided into a radical systematic mediastinal lymphadenectomy (LA) group and a mediastinal lymph node sampling (LS) group. Impacts on morbidity, N staging, overall survival (OS) and disease-free survival (DFS) were evaluated in each group respectively. Associations between clinical-pathological parameters (age, sex, tumor location, tumor size, pathological type and lymph node metastases) and OS, DFS were analyzed. The cumulative OS and DFS was calculated by the Kaplan-Meier method and compared by the Log-rank test.
RESULTSThe mean number of dissected lymph nodes was (15.98 +/- 3.05) in LA group and (6.48 +/- 2.16) in LS group with a significant difference (P < 0.01). No statistically significant difference existed in modification of N staging, OS and DFS between LA group and LS group. However, for patients with lesions of a diameter more than 2 cm, 5-year OS in LA group was significantly higher than that in LS groups (LA vs. LS = 78.2% vs. 54.5% ,P < 0.05), also 5-year DFS was significantly higher (LA vs. LS = 75.1% vs. 51.3%, P < 0.05). For patients with lesions of 2 cm or less, 5-year OS and 5-year DFS were similar in both groups. The early surgery-related parameters (duration of surgery, drain secretion and morbidity) indicated a slighter invasion in LS group. In addition, patients with large cell carcinoma and adenosquamous carcinoma were associated with significantly poor 5-year OS (P < 0.05) , and patients with lymph node metastases were associated with poor 5-year OS as well as 5-year DFS (P < 0.01).
CONCLUSIONSAfter being intraoperatively identified as T1 stage, patients with lesions of more than 2 cm in clinical-stage IA non-small cell lung cancer should be performed with LA to get a better survival, and patients with lesions of 2 cm or less should be performed with LS to decrease invasion.
