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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 48-53, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TW Shields
The significance of the presence of N2 disease in patients with non- small
cell cancer of the lung is widely misunderstood. Long-term survival rates
from 15% to more than 30% after surgical resection are frequently reported
in the literature. However, these percentages represent only the surgical
results in a highly selected and unfortunately small proportion of the
entire number of patients with N2 disease. In those patients in whom N2
disease is readily clinically recognizable or is identified by standard
roentgenographic or bronchoscopic study and proved by biopsy or is
discovered by prethoracotomy mediastinal exploration, a 5-year survival
rate of only approximately 2% for the entire group can be expected, even
when aggressive surgical resection is performed when appropriate. In those
patients in whom the N2 disease is only initially recognized at
thoracotomy, the resectability rate is higher and 5-year survival rates as
noted are in the range of 15% to 30%. Although surgical resection continues
to be the primary choice of therapy in this small group (less than 20% of
patients with N2 disease), surgical resection can be expected to salvage
only 3% to 6% of all patients with N2 disease. Thus, with presently
available therapy, the vast majority of patients proved to have N2 disease
will die of their lung cancer. It must be concluded that N2 disease is a
significant poor prognostic factor in patients with lung cancer.
ARTICLES
The significance of ipsilateral mediastinal lymph node metastasis (N2 disease) in non-small cell carcinoma of the lung. A commentary
Northwestern University Medical School, Chicago, IL 60611.
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