What alters prognosis in patients who were operated for lung cancer with lymph node metastasis?

• Published in: ANZ journal of surgery Vol. 94; no. 10; pp. 1781 - 1786
• Main Authors: Cimenoglu, Berk, Ozdemir, Attila, Buz, Mesut, Dogruyol, Talha, Turan, Nedim, Demirhan, Recep
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2024; Blackwell Publishing Ltd
• Subjects: Adult; Aged; Avidity; Computed tomography; Disease-Free Survival; Female; Health services; Humans; Ligaments; Lung cancer; Lung diseases; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision - methods; Lymph nodes; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Male; mediastinal lymph nodes; Mediastinum; Medical prognosis; Metastases; Metastasis; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Patients; Pneumonectomy - methods; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Prognosis; Retrospective Studies; Survival; Survival Rate; Tomography; lung cancer; mediastinal lymph nodes; survival
• ISSN: 1445-1433; 1445-2197; 1445-2197
• DOI: 10.1111/ans.19177

Introduction In this study, we investigated the clinical outcomes of patients who underwent surgery with proven lymph node metastasis. Methods Patients who were operated for lung cancer with pN1 or pN2 were examined in the study. The clinicopathological features and survival of the subjects were evaluated according to pN1‐pN2 status, presence of neoadjuvant treatment, Positron emission tomography and computed tomography (PET/CT) avidity on mediastinal lymph nodes and specific lymph node stations. Results The study examines 100 patients operated from January 2016 to December 2021. Number of cases with pN1 and pN2 disease were 45 (45%) and 55 (55%) respectively. Thirty (30%) patients received neoadjuvant treatment. The 5‐year overall survival (OS) and disease‐free survival (DFS) of the patients were computed as 42.5% and 42.4% correspondingly. The 5‐year cancer‐related survival was 55.3%. In pN2 cohort, 5‐year DFS was 67.9% in the neoadjuvant group and 15.9% in the non‐neoadjuvant group (P = 0.042). In non‐neoadjuvant group, 5‐year DFS was 19.9% in cases with mediastinal PET/CT avidity and 56.3% in patients without mediastinal PET/CT avidity (P = 0.018). In pN2 disease, the presence of subcarinal or paratracheal lymph node metastasis did not create a significant difference in 5‐year OS or DFS, but pulmonary ligament lymph node metastasis was found to be linked with worse survival in both 5‐year OS (P = 0.005) and DFS (P = 0.017). Conclusion The main elements related with poor prognosis were absence of neoadjuvant treatment and pulmonary ligament lymph node metastasis in pN2 disease, detecting PET/CT avid mediastinal lymph nodes in non‐neoadjuvant group. The main elements related with poor prognosis in patients with lymph node metastasis operated for lung cancer were absence of neoadjuvant treatment and pulmonary ligament lymph node metastasis in pN2 disease, detecting PET/CT avid mediastinal lymph nodes in non‐neoadjuvant group and metastasis to three or more lymph nodes.