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J. Ohsawa

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    P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P1.03-003 - A Clinicopathological Study of Resected Small-Sized Non-Small Cell Lung Cancer 2 cm or Less in Diameter with N2 Lymph Node Metastasis (ID 1348)

      09:30 - 17:00  |  Author(s): J. Ohsawa

      • Abstract
      • Slides

      The detection of small-sized (≤ 2 cm) non-small cell lung cancer (NSCLC) has increased with the development of high-resolution computed tomography. The reported 5-year survival rate of T1a (≤ 2 cm) N0M0 patients is more than 80%, and that of p-T (≤ 2 cm) N2M0 patients has also steadily improved.

      Between January 1991 and December 2011, a total of 917 patients with small-sized NSCLC underwent curative pulmonary resection with systematic lymph node dissection by open thoracotomy or video-assisted thoracic surgery at our hospital. We retrospectively evaluated their postoperative clinical outcomes and survival rates. Survival was analyzed using the Kaplan-Meier method and log-rank test.

      There were 57 (6.2%) patients with mediastinal lymph node metastasis (pN2 disease). The distributions of the histological types were adenocarcinoma 41 cases, squamous cell carcinoma 11, large cell carcinoma 4, and carcinoid 1. The procedures included lobectomy in 48 cases, segmentectomy in 6, and pneumonectomy in 3. The respectively status of lymph node metastasis was single station in 36 cases and multiple station in 21. Skip lymph node metastasis (no hilum lymph node metastasis) was observed in 13 cases. In 44 cases, there was both hilum lymph node and mediastinal lymph node metastases. There were 34 cases (59.6%) that were upstaged from preoperative clinical diagnosis (cN0 or N1). The median overall survival period and 5 year survival of the 57 patients with pN2 was 43.5 months and 41%. The recurrence rate was 70% (40/57) and the median disease-free interval was 41.3 months. Of the 18 patients without recurrence, 14 (77.8%) had single station mediastinal metastasis. The 5-year overall survival rates with multiple station or single station mediastinal metastases were 34.5% and 48.9%, respectively (NS). The 5-year overall survival rates with multiple (hilum and mediastinal) station lymph node metastases and only mediastinal station lymph node metastasis were 37.7% and 64.8%, respectively.

      This study showed that 6.2% of small-sized NSCLC had N2 disease. Moreover, 59.6% of small-sized NSCLC was upstaged from clinical diagnosis to pathological diagnosis. Single station mediastinal metastases showed a longer overall survival rate (64.8%) than multiple station mediastinal lymph node metastases. Therefore, we recommend systematic lymph node dissection for local treatment as well as accurate diagnosis. As multiple mediastinal node metastases showed an unfavorable prognosis, surgery combined with systematic treatment is recommended.

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