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J Thorac Cardiovasc Surg 2009;138:849-858
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Is there a subset of patients with preoperatively diagnosed N2 non–small cell lung cancer who might benefit from surgical resection?

^a Unit of Thoracic Surgery, Department of Surgical Oncology, National Cancer Research Institute, Genoa, Italy
^b Unit of Clinical Epidemiology, Department of Epidemiology and Prevention, National Cancer Research Institute, Genoa, Italy
^c Department of Cardiothoracic Surgery, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy

Received for publication August 18, 2008; revisions received February 6, 2009; accepted for publication March 8, 2009.

^_* Address for reprints: Giovanni B. Ratto, MD, Unit Thoracic Surgery, Department Surgical Oncology, National Cancer Research Institute, Largo Rosanna Benzi 10, 16132 Genoa, Italy. (Email: giovanni.ratto{at}ospedalesantacorona.it).

Objective: The role of surgery in the treatment of preoperatively diagnosed N2 non–small cell lung cancer remains controversial. This study sought significant prognostic factors to select candidates for surgery and assess prognosis.

Methods: The study population included 277 patients who underwent primary resection (192) or induction chemotherapy followed by surgery (85) for preoperatively diagnosed, potentially resectable N2 non–small cell lung cancer. N2 descriptors were prospectively recorded. Kaplan–Meier curves were used to evaluate survival, and statistical significance of differences between curves was assessed by log-rank test. Cox regression was used for multivariate analyses.

Results: Preoperative significant prognostic factors were number of mediastinal node levels involved (P < .001), symptom severity (P = .013), clinical T (P = .041), and induction chemotherapy (P = .001). Three groups with different prognoses were based on individual prognostic score. The group that did best had a median survival of 29.6 months. Postoperative predictors of survival were pathologic T (P = .003), tumor residue (P = .034), and number of mediastinal nodes involved (P < .001). Of 3 groups with different prognoses, the most favorable had a median survival as long as 42 months.

Conclusion: This study provides a practical tool that uses significant prognostic factors to predict which patients with preoperatively diagnosed N2 non–small cell lung cancer have better prognoses. Because patients with the favorable prognostic factors showed good long-term survival and excellent local disease control, surgery should still play an important role in the multimodality treatment of these patients.