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BACKGROUND: N1 non-small cell lung cancer (NSCLC) afflicts a heterogeneous group of patients with a 5-year survival of approximately 40% following pulmonary resection. A paucity of information exists, in this disease group, regarding predisposing factors to loco-regional and distant metastatic recurrence and long-term survival.
METHODS: From 1997-2002, all patients with N1 NSCLC who had undergone a complete resection with systematic mediastinal lymph node dissection were retrospectively analyzed for factors associated with recurrence and long-term survival.
RESULTS: There were 180 patients (68% men). Mean age was 65 years. Sixty-six patients (37%) developed recurrence (41 distant, 39 local). Factors adversely affecting loco-regional recurrence by univariate analysis were visceral pleural invasion and patient age. Visceral pleural invasion, distinct metastatic N1 lymph node involvement (as opposed to N1 involvement by direct extension of the primary tumor), and multiple node involvement were associated with development of metachronous distant metastases. Multivariate analysis demonstrated that visceral pleural invasion, distinct metastatic N1 involvement, and multiple node involvement were the only independent predisposing factors for both loco-regional and distant recurrence. Overall five-year survival was 42.5%. A significant adverse influence on survival was observed with increasing pathologic T-stage, tumor size, tumor grade and visceral pleural invasion.
CONCLUSIONS: Visceral pleural invasion, distinct metastatic N1 involvement and multiple node metastases are independent predictors of loco-regional and distant metastatic recurrence. Advanced T-stage, visceral pleural invasion, tumor size and grade were predictors of poor survival. Because of this poor prognosis, these patients represent a subgroup of N1 patients that may benefit from adjuvant chemotherapy.