Adjuvant chemotherapy may improve outcome of patients with non-small-cell lung cancer with metastasis of intrapulmonary lymph nodes after systematic dissection of N1 nodes

摘要

Objective:Survival benefit of adjuvant chemotherapy (AC) of patents with intrapulmonary lymph node (IPLN) metastasis (level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.Methods:First,155 consective cases of lung cancer confirmed as pathologic N 1 were collected and evaluated.Patents received systematic dissection of N2 and N1 nodes.For patients with IPLN metastasis,survival outcomes were compared between those receiving AC and those not receiving AC.Results:In this group,112 cases (72.3％) had IPLN metastasis and 55 cases (35.5％) had N1 involvement limited to level 13-14 without further disease spread to higher levels.Patients with IPLN involvement had a better prognosis than that of patents with hilar-interlobar involvement.For the intrapulmonary N1 group (level 12-14-positive,level 10-11-negative or unknown,n=112),no survival benefit was found between the AC group and non AC group [5-year overall survival (OS):54.6±1.6 vs.50.4±2.4 months,P=0.177].However,76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports (level 12-14-positive,level 10-11 both negative),oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup (5-year OS:57.3±1.5 vs.47.1±3.2 months,P=0.002).Conclusions:Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.