Abstract
Preoperative N-staging is one of the most important aspects in management of non-small cell lung cancer (NSCLC) patients because it has a crucial impact on prognosis of patients and helps to choose the optimal treatment plan.
The aim of our study was to evaluate and compare long-term results of operated NSCLC patients with different preoperative N-staging protocols.
Material and methods: 319 patients with resectable NSCLC were operated in our center in 2003-2008. In group 1 all patients preoperatively underwent mediastinoscopy in addition to non-invasive staging procedures (CT and PET), whereas in group 2 N-staging protocol included only CT and PET. Final TNM stage was verified based on intraoperative findings including mediastinal lymph nodes dissection. Long-term survival was assessed by Kaplan-Meier method.
Results: In group 1 significantly less unforeseen N2 were revealed during intraoperative lymph nodes dissection in comparison to group 2 (10% vs 27%, respectively, p<0,05), the rate of uncertain resections was also lower in group 1 than in group 2 (5% vs 14%, respectively, p<0,05). Analysis of long-term results showed better survival in group 1 than in group 2 (5-yr survival 61% vs 43%, respectively, p<0,05). This difference was more prominent in patients with central NSCLC (5-yr survival 65% vs 39%, respectively, p<0,01).
Conclusion: Our findings suggest that including mediastinoscopy in preoperative N-staging protocol of potentially operable NSCLC patients improves the selection of surgical candidates by excluding patients with extended disease, that results in better long-term survival of operated patients.
- © 2011 ERS