Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Risk Factors for Recurrence in Completely Resected pT1/2N1 Non-small Cell Lung Cancer

완전 절제된 pT1/2N1 비세포폐암에서 수술 후 재발의 위험 인자

  • Park Inkyu (Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine) ;
  • Chung Kyung Young (Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine) ;
  • Kim Kil Dong (Department of Thoracic and Cardiovascular Surgery, Eulji University School of Medicine) ;
  • Joo Hyun Chul (Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine) ;
  • Kim Dae Joon (Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine)
  • 박인규 (연세대학교 의과대학 흉부외과학교실) ;
  • 정경영 (연세대학교 의과대학 흉부외과학교실) ;
  • 김길동 (을지대학교 의과대학 흉부외과학교실) ;
  • 주현철 (연세대학교 의과대학 흉부외과학교실) ;
  • 김대준 (연세대학교 의과대학 흉부외과학교실)
  • Published : 2005.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Complete surgical resection is the most effective treatment for pT1/2N1 non-small cell lung cancer, however 5 year survival rate of these patients is about $40\%$ and the major cause of death is recurrent disease. We intended to clarify the risk factors of recurrence in completely resected pT1/2N1 non-small cell lung cancer. Material and Method: From Jan. f990 to Jul. 2003, total of 117 patients were operated for pT1/2N1 non-small cell lung cancer. The risk of recurrence according to patients characteristics, histopathologic findings, type of resection, pattern of lymph node metastasis, postoperative adjuvant treatment were evaluated retrospectively. Result: Mean age of patients was 59.3 years. There were 14 patients with T1N1 and 103 patients with T2N1 disease. Median follow-up time was 27.5 months and overall 5 year suwival rate was $41.3\%$. 5 year freedom-from recurrence rate was $54.1\%$. Recurrence was observed in $44 (37.6\%)$ patients and distant recurrence developed in 40 patients. 5 year survival rate of patients with recurence was $3.3\%$, which was significantly lower than patients without recurrence $(61.3\%,\;p=0.000).$ In multi-variate analysis of risk factors for freedom-from recurrence rate, multi-station N1 $(hazard\;ratio=1.997,\;p=0.047)$ was a poor prognostic factor. Conclusion: Multi-station N1 is the risk factor for recurrence in completely resected pT1/2N1 non-small cell lung cancer.

완전절제는 pT1/2N1 비소세포폐암의 가장 효과적인 치료 방법이지만 수술 후 5년 생존율은$40\%$정도이며 많은 환자가 암의 재발로 사망하게 된다. 완전 절제된 pT1/2Nl 비소세포폐암에서 재발에 영향을 주는 인자를 규명하고자 하였다. 대상 및 방법: 1990년 1월부터 2003년 7월까지 연세대학교 의과대학 세브란스병원 흉부외과에서 pT1/2N1 비소세포폐암으로 수술받은 환자 117명을 대상으로 환자의 특성, 조직병리학적 소견, 수술방법, 림프절 전이 양상, 술 후 보조요법 등과 재발과의 관계를 후향적으로 연구하였다. 결과: 전체 환자의 평균 연령은 $59.3\pm9.1$세였으며 T1N1이 14명, T2N1이 103명이었다. 추적관찰기간은 27.5개월이었으며 5년 생존율은 $41.3\%$였다. 수술 후 재발은 44명$(37.6\%)$에서 관찰되었으며 원격전이가 40명이었다. 재발한 환자의 5년 생존율은 $3.3\%$로 재발이 없는 환자$(61.3\%)$에 비해 유의하게 낮았으며(p=0.000), 전체 환자의 5년 무재발률(freedom-from recurrence rate)은 $54.1\%$였다. 무재발률에 영향을 미치는 요인에 대한 다변량 분석 결과 다림프절군 N1 (multi-station N1)이 단일림프절군 N1 (single station N1)에 비해 재발의 위험도가 1.997배 높았다(p=0.047). 걸론: 완전 절제된 pT1/2N1 비소세포폐암 환자들에서 다림프절군 N1이 수술 후 재발의 위험인자였다.

Keywords

References

  1. Mountain CF. Revision in the international system for staging lung cancer. Chest 1997;111:1710-7 https://doi.org/10.1378/chest.111.6.1710
  2. Tanaka F, Yanagihara K, Otake Y, et al. Prognostic factors in patients with resected pathologic (p) T1-2N1M0 non-small cell lung cancer. Eur J Cardio Thorac Surg 2001;19:555-561 https://doi.org/10.1016/S1010-7940(01)00670-4
  3. Osaki T, Nagashima A, Yoshimatsu T, Tashima Y, Yasumoto K. Survival and characteristics of lymph node involvement in patients with N1 non-small cell lung cancer. Lung Cancer 2004;43:151-7 https://doi.org/10.1016/j.lungcan.2003.08.020
  4. Sayar A, Turna A, Solak O, Urer N, Gurses A. Prognostic significance of surgical-pathologic multistation N1 disease in non-small cell carcinoma of the lung. Eur J Cardiothorac Surg 2004;25:434-8 https://doi.org/10.1016/j.ejcts.2003.12.005
  5. van Velzen E, Snijder RJ, de la Riviere AB, Elbers HRJ, van den Bosch JMM. Lymph node type as a prognostic factor for survival in T2N1M0 non-small cell lung carcinoma. Ann Thorac Surg 1997;63:1436-40 https://doi.org/10.1016/S0003-4975(97)00089-1
  6. Scott WJ, Howington J, Movsaa B. Treatment of stage II non-small cell lung cancer. Chest 2003;123:188S-201S https://doi.org/10.1378/chest.123.1_suppl.188S
  7. Naruke T, Suemasu K, Ishogawa S. Lymph node mapping and curability at various level of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:832-9
  8. Travis WD, Colby TV, Corrin B, Shimosato Y, Brambilla E. World health organization international histologic classification of tumours. 3rd ed. Springer-Verlag. 1999
  9. Naruke T, Tsuchiya R, Kondo H, Asamura H. Prognosis and survival after resection for bronchogenic carcinoma. Based on the 1997 TNM-staging Classificaiton: The Japanese experience. Ann Thorac Surg 2001;71:1759-64 https://doi.org/10.1016/S0003-4975(00)02609-6
  10. van Rens MTM, de la Riviere AB, Elbers HRJ, van den Bosch JMM. Prognostic assessment of 2361 patients who underwent pulmonary resection for non-small cell lung cancer, Stage I,II, and IIIA. Chest 2000;117:374-9 https://doi.org/10.1378/chest.117.2.374
  11. Ichinose Y, Yano T, Asoh H, Yokoyama H, Yoshino I, Kaysuda Y. Prognostic factors obtained by a pathologic examination in completely resected non-small cell lung cancer. An analysis in each pathologic stage. J Thorac Cadiovasc Surg 1995;110:601-5 https://doi.org/10.1016/S0022-5223(95)70090-0
  12. Yano T, Yokoyama H, Inoue T, Asoh H, Tayama K. Ichinose Y. Surgical results and prognostic factors of pathologic N1 disease in non-small cell carcinoma of the lung. J Thorac Cardiovasc Surg 1994;107:1398-402
  13. Rea F, Marulli G, Callegaro D, et al. Prognostic significance of main bronchial lymph nodes involvement in non-small cell lung carcinoma: N1 or N2? Lung Cancer 2004;45:215-20 https://doi.org/10.1016/j.lungcan.2004.01.017
  14. Riquet M, Manac'h D, Le Pimpec-Barthes F, Dujon A, Chehab A. Prognostic significance of surgical-pathologic N1 disease in non-small cell carcinoma of the lung. Ann Thorac Surg 1999;67:1572-6 https://doi.org/10.1016/S0003-4975(99)00276-3
  15. Sawyer TE, Bonner JA, Gould PM, et al. Factors predicting patterns of recurrence after resection of N1 non-small cell lung carcinoma. Ann Thorac Surg 1999;68:1171-6 https://doi.org/10.1016/S0003-4975(99)00678-5
  16. Marra A, Hillejan L, Zaboura G, Fujimoto T, Greschuchna A, Stamatis G. Pathologic N1 non-small cell lung cancer: Correlation between pattern of lymphatic spread and prognosis. J Thorac Cardiovasc Surg 2003;125:543-53 https://doi.org/10.1067/mtc.2003.322
  17. Keller S, Adak S, Wagner H, Johnson DH. Mediastinal lymph node dissection improves survival in patients with Stage II and IIIa non-small cell lung cancer. Ann Thorac Surg 2000;70:358-66 https://doi.org/10.1016/S0003-4975(00)01673-8
  18. Arriagata R, Bergan B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J. The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin based adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. N Engl J Med 2004;350:351-60 https://doi.org/10.1056/NEJMoa031644
  19. Winton TL, Livingston R, Johnson D, et al. A prospective randomised trial of adjuvant vinorelbine (VIN) and cisplatin (CIS) in completely resected stage IB and II non small cell lung cancer. Intergroup JBR.10. J Clin Oncol (Meeting Abstracts) 2004;22:7018 https://doi.org/10.1200/jco.2004.22.14_suppl.7018
  20. Strauss M, Herndon J, Maddaus MA, et al. Randomized clinical trial of adjuvant chemotherapy with paclitaxel and carboplatin following resection in Stage IB non-small cell lung cancer: Report of Cancer and Leukemia Group B (CALGB) Protocol 9633. J Clin Oncol (Meeting Abstracts) 2004;22:7019 https://doi.org/10.1200/jco.2004.22.14_suppl.7019