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Hirotoshi Horio



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    P1 - Poster Viewing (ID 5)

    • Event: NACLC 2019
    • Type: Poster Session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 10/11/2019, 16:45 - 18:00, Exhibit Hall
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      P1.03 - Survival Benefit of Surgically Resected Occult N2 (c-N0,1 and p-N2) Non-small-Cell Lung Cancer (ID 80)

      16:45 - 18:00  |  Author(s): Hirotoshi Horio

      • Abstract

      Background:
      In patients (pts.) with cN0-cN1 non–small cell lung cancer (NSCLC) unexpectedly are found to have N2 disease at the time of thoracoscopy or thoracotomy. The objective of this study was to determine the incidence and survival of patients who have completely resected, non-small-cell, stage IIIA, lung cancer from occult (so called unsuspected) N2 disease.


      Method:
      Between January 2008 and December 2011, 284 NSCLC pts. with clinically mediastinal node negative disease (cT1-cT3 cN0-cN1) underwent surgery. All pts. underwent computed tomography scan with contrast, R0 resection with systematic lymph node dissection, and had occult, pathologic N2, NSCLC. Positron emission tomography scan or invasive staging was added in the attending physician’s choice. Occult pN2 pattern and outcomes were retrospectively analyzed for this cohort.


      Results:
      Among 284 pts., cN0 and cN1 were 270 (95.1%) and 14 pts. (4.9%), respectively. Occult pN2 disease was found in 31 patients (10.9%) who underwent lobectomy or segmentectomy as primary therapy for cT1-cT3 cN0-cN1 NSCLC. Of these, cN0pN2 and cN1pN2 were 26 (9.2%) and 5 (1.7%) pts., respectively. Compare to cN0 group, unsuspected pN2 was more frequent in the cN1 group; (cN0/pN2=270/26 vs cN1/N2=14/5 pts.; p=.0023). In terms of the pattern of metastasis, multiple and single pN2 was observed similarly in cN0 and cN1 group (p=.9484). The 5-year overall survival of the entire unsuspected pN2 was 68.5%, and cN0pN2 cohort tended to have better prognosis than cN1pN2 cohort (71.1%(cN0pN2) vs. 50.0%(cN1pN2); p=.0898). No significant difference in 5y-OS between unsuspected single and multiple pN2 could be seen; (70.5%(single) vs. 66.7%(multiple); p=.07803).


      Conclusion:
      This analysis suggests that, in the setting of occult pN2 NSCLC, proceeding with anatomic surgery does not appear to compromise outcomes. As occult pN2 disease was more frequent in cN1 cohort and revealed poor prognosis, perioperative invasive mediastinal staging and additional therapy should be considered.