Surgical Therapeutic Strategy for Non-small Cell Lung Cancer with Mediastinal Lymph Node Metastasis(

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Background and objective Approximately 30% of patients who are diagnosed with non-small cell lung cancer(NSCLC)are classified as N2 on the basis of metastasis to the mediastinal lymph nodes.The effectiveness of surgery for these patients remainscontroversial.Although surgeries in recent years are proved to be effective to some extent,yet due to many reasons,5-yearsurvival rate after surgery varies greatly from patient to patient.Thus it is necessary to select patients who have ahigh probability of being be cured through an operation,who are suitable to receive surgery and the best surgical methods so as to figure out the conditions under which surgical treatment can be chosen and the factors that may influence prognosis.Methods 165 out of l73 patients with N2NSCLC were treated with surgery in our department from January 1999 to May 2003,among whom 130 were male,43 female and the sex ratio was 3:1,aver age age 53,ranging from 29 to 79.The database covers the patients'complete medical history including the information of their age,sex,location and size of tumor date of operation,surgical methods,histologic diagnosis,clinical stage,post-operative TNM stage,neoadjuvant treatment and chemoradiotherapy.The methods of clinical stage verification include chest X-ray,chest CT,PET,mediastinoscopy,bronchoscope(+?),brain CT or MRI,abdominal B ultrasound (or CT),and bone ECT.The pathological classification was based on the international standard for lungcancer(UICC1997).Survival time was analyzed from the opemtion date to May 2008 with the aid of SPSS(Statistical Package forthe Social Sciences)program.Kaplan-Meier survival analysis,Log-rank test and Cox multiplicity were adopted respectively to obtain patients'slLrvival curve,survival rate and the impact possible factors may have on their survival rate.Results The median survival tinle was 22 months.with 3-year survival rate reaching 28.1%and 5-year survival rate reaching 19.0%.Age,sex.different histological classification and postoperative chemoradiotherapy seem to have no correlation with 5-yearsurvival rate.In all N2 subtypes,5-year survival rate is remarkably higher for unexpected N2 discovered at thoractomy and proven N2 stage before preoperative work-up and receive a mediastinal down-staging after induction therapy (P
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