N2 Disease in T1 Non-Small Cell Lung Cancer

Sebastian A. Defranchi, Stephen D. Cassivi, Francis C. Nichols, Mark S. Allen, K. Robert Shen, Claude Deschamps, Dennis A Wigle

Research output: Contribution to journalArticle

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Abstract

Background: The optimal management strategy for mediastinal staging in early-stage non-small cell lung cancer (NSCLC) is not clearly defined. The true prevalence of mediastinal lymph node metastases (N2 disease) in resected pathologic T1 (pT1) NSCLC must be known to define the role of invasive mediastinal staging in these patients. Methods: Data of patients with pT1 lesions resected at Mayo Clinic between 1998 and 2006 were retrospectively reviewed. Patients with N2 disease were identified from pathology and operative reports. We reviewed demographics, radiologic data, and surgical procedures for those with pathologic T1 N2 NSCLC. Results: We identified 968 cases of pT1 lesions, 59 with pN2 disease (6.1%). For those with T1 N2 disease, the primary lung lesion was peripheral in 18 (31%) and central in 41 (69%). Of these, 36 had negative non-invasive mediastinal staging (3.7%) and were incidentally discovered. The most frequently affected lymph node station was 7 in 22 patients (37%), followed by 5,6 in 18 (31%). Mediastinoscopy found positive lymph nodes in 3 of 16 patients (19%) in which it was performed. Overall 5-year survival for pT1 N2 incidentally discovered during mediastinal lymph node dissection at the time of lung resection was 46% (95% confidence interval, 31% to 68%). Conclusions: True pT1 NSCLC harbors a relatively low rate of N2 disease. The rate of occult N2 disease not observed on noninvasive preoperative mediastinal staging is even lower. For patients with T1 NSCLC and negative mediastinal imaging, routine mediastinoscopy results in a low yield of occult N2 disease discovery.

Original languageEnglish (US)
Pages (from-to)924-928
Number of pages5
JournalAnnals of Thoracic Surgery
Volume88
Issue number3
DOIs
StatePublished - Sep 2009

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Non-Small Cell Lung Carcinoma
Mediastinoscopy
Lymph Nodes
Lymph Node Excision
Lung Diseases
Demography
Confidence Intervals
Pathology
Neoplasm Metastasis
Lung
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Defranchi, S. A., Cassivi, S. D., Nichols, F. C., Allen, M. S., Shen, K. R., Deschamps, C., & Wigle, D. A. (2009). N2 Disease in T1 Non-Small Cell Lung Cancer. Annals of Thoracic Surgery, 88(3), 924-928. https://doi.org/10.1016/j.athoracsur.2009.05.039

N2 Disease in T1 Non-Small Cell Lung Cancer. / Defranchi, Sebastian A.; Cassivi, Stephen D.; Nichols, Francis C.; Allen, Mark S.; Shen, K. Robert; Deschamps, Claude; Wigle, Dennis A.

In: Annals of Thoracic Surgery, Vol. 88, No. 3, 09.2009, p. 924-928.

Research output: Contribution to journalArticle

Defranchi, SA, Cassivi, SD, Nichols, FC, Allen, MS, Shen, KR, Deschamps, C & Wigle, DA 2009, 'N2 Disease in T1 Non-Small Cell Lung Cancer', Annals of Thoracic Surgery, vol. 88, no. 3, pp. 924-928. https://doi.org/10.1016/j.athoracsur.2009.05.039
Defranchi SA, Cassivi SD, Nichols FC, Allen MS, Shen KR, Deschamps C et al. N2 Disease in T1 Non-Small Cell Lung Cancer. Annals of Thoracic Surgery. 2009 Sep;88(3):924-928. https://doi.org/10.1016/j.athoracsur.2009.05.039
Defranchi, Sebastian A. ; Cassivi, Stephen D. ; Nichols, Francis C. ; Allen, Mark S. ; Shen, K. Robert ; Deschamps, Claude ; Wigle, Dennis A. / N2 Disease in T1 Non-Small Cell Lung Cancer. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 3. pp. 924-928.
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title = "N2 Disease in T1 Non-Small Cell Lung Cancer",
abstract = "Background: The optimal management strategy for mediastinal staging in early-stage non-small cell lung cancer (NSCLC) is not clearly defined. The true prevalence of mediastinal lymph node metastases (N2 disease) in resected pathologic T1 (pT1) NSCLC must be known to define the role of invasive mediastinal staging in these patients. Methods: Data of patients with pT1 lesions resected at Mayo Clinic between 1998 and 2006 were retrospectively reviewed. Patients with N2 disease were identified from pathology and operative reports. We reviewed demographics, radiologic data, and surgical procedures for those with pathologic T1 N2 NSCLC. Results: We identified 968 cases of pT1 lesions, 59 with pN2 disease (6.1{\%}). For those with T1 N2 disease, the primary lung lesion was peripheral in 18 (31{\%}) and central in 41 (69{\%}). Of these, 36 had negative non-invasive mediastinal staging (3.7{\%}) and were incidentally discovered. The most frequently affected lymph node station was 7 in 22 patients (37{\%}), followed by 5,6 in 18 (31{\%}). Mediastinoscopy found positive lymph nodes in 3 of 16 patients (19{\%}) in which it was performed. Overall 5-year survival for pT1 N2 incidentally discovered during mediastinal lymph node dissection at the time of lung resection was 46{\%} (95{\%} confidence interval, 31{\%} to 68{\%}). Conclusions: True pT1 NSCLC harbors a relatively low rate of N2 disease. The rate of occult N2 disease not observed on noninvasive preoperative mediastinal staging is even lower. For patients with T1 NSCLC and negative mediastinal imaging, routine mediastinoscopy results in a low yield of occult N2 disease discovery.",
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AU - Cassivi, Stephen D.

AU - Nichols, Francis C.

AU - Allen, Mark S.

AU - Shen, K. Robert

AU - Deschamps, Claude

AU - Wigle, Dennis A

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N2 - Background: The optimal management strategy for mediastinal staging in early-stage non-small cell lung cancer (NSCLC) is not clearly defined. The true prevalence of mediastinal lymph node metastases (N2 disease) in resected pathologic T1 (pT1) NSCLC must be known to define the role of invasive mediastinal staging in these patients. Methods: Data of patients with pT1 lesions resected at Mayo Clinic between 1998 and 2006 were retrospectively reviewed. Patients with N2 disease were identified from pathology and operative reports. We reviewed demographics, radiologic data, and surgical procedures for those with pathologic T1 N2 NSCLC. Results: We identified 968 cases of pT1 lesions, 59 with pN2 disease (6.1%). For those with T1 N2 disease, the primary lung lesion was peripheral in 18 (31%) and central in 41 (69%). Of these, 36 had negative non-invasive mediastinal staging (3.7%) and were incidentally discovered. The most frequently affected lymph node station was 7 in 22 patients (37%), followed by 5,6 in 18 (31%). Mediastinoscopy found positive lymph nodes in 3 of 16 patients (19%) in which it was performed. Overall 5-year survival for pT1 N2 incidentally discovered during mediastinal lymph node dissection at the time of lung resection was 46% (95% confidence interval, 31% to 68%). Conclusions: True pT1 NSCLC harbors a relatively low rate of N2 disease. The rate of occult N2 disease not observed on noninvasive preoperative mediastinal staging is even lower. For patients with T1 NSCLC and negative mediastinal imaging, routine mediastinoscopy results in a low yield of occult N2 disease discovery.

AB - Background: The optimal management strategy for mediastinal staging in early-stage non-small cell lung cancer (NSCLC) is not clearly defined. The true prevalence of mediastinal lymph node metastases (N2 disease) in resected pathologic T1 (pT1) NSCLC must be known to define the role of invasive mediastinal staging in these patients. Methods: Data of patients with pT1 lesions resected at Mayo Clinic between 1998 and 2006 were retrospectively reviewed. Patients with N2 disease were identified from pathology and operative reports. We reviewed demographics, radiologic data, and surgical procedures for those with pathologic T1 N2 NSCLC. Results: We identified 968 cases of pT1 lesions, 59 with pN2 disease (6.1%). For those with T1 N2 disease, the primary lung lesion was peripheral in 18 (31%) and central in 41 (69%). Of these, 36 had negative non-invasive mediastinal staging (3.7%) and were incidentally discovered. The most frequently affected lymph node station was 7 in 22 patients (37%), followed by 5,6 in 18 (31%). Mediastinoscopy found positive lymph nodes in 3 of 16 patients (19%) in which it was performed. Overall 5-year survival for pT1 N2 incidentally discovered during mediastinal lymph node dissection at the time of lung resection was 46% (95% confidence interval, 31% to 68%). Conclusions: True pT1 NSCLC harbors a relatively low rate of N2 disease. The rate of occult N2 disease not observed on noninvasive preoperative mediastinal staging is even lower. For patients with T1 NSCLC and negative mediastinal imaging, routine mediastinoscopy results in a low yield of occult N2 disease discovery.

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