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From the Department of Thoracic Surgery, Kyoto University (FT, KY, YK, RM, KT, HK, SI, HW), Kyoto; Department of Thoracic Surgery, Seishin-iryo Center Hospital (YO), Kobe; and Department of Radiology, Fukui Medical University (HI), Fukui, Japan.
Correspondence: Address correspondence and reprint requests to: Fumihiro Tanaka, MD, Department of Thoracic Surgery, Faculty of Medicine, Kyoto University, Shogoin-kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan; Fax: 81-075-751-4974; e-mail: ftanaka{at}kuhp.kyoto-u.ac.jp
Background: Postoperative prognosis for patients with pathologic (p-) stage IIIA-N2 non-small-cell lung cancer (NSCLC) is poor, and significant factors that influence the prognosis remain unclear.
Methods: A total of 99 patients who underwent complete resection for p-stage IIIA-N2 NSCLC without any preoperative therapy were retrospectively reviewed. Biological features such as tumor angiogenesis (intratumoral microvessel density [IMVD]), proliferative activity (proliferative index [PI]), and p53 status were also evaluated immunohistochemically.
Results: Univariate analysis revealed that the number of involved N2 stations was a significant prognostic factor; 5-year survival rates for a tumor with metastases in single N2 stations, tumor with metastases in two N2 stations, and tumor with metastases in 3 or more N2 stations were 41.6%, 35.3%, and 0.0%, respectively (P = .041) In addition, the 5-year survival rate for cN0-1 disease was significantly higher than that for cN2 disease (41.9% and 25.5%, respectively; P = .048) Tumor angiogenesis and proliferative activity were the most significant prognostic factors; 5-year survival rates for lower-IMDV tumor and higher-IMVD tumor were 53.6% and 15.9%, respectively (P = .002), and those for lower-PI tumor and higher-PI tumor were 47.0% and 20.4%, respectively (P = .019) There was no difference in the postoperative survival between tumor showing aberrant p53 expression and tumor showing no aberrant p53 expression. These results were confirmed by a multivariate analysis.
Conclusions: P-stage IIIA-N2 NSCLC cases represented a mixture of heterogeneous prognostic subgroups, and the number of involved N2 stations, cN status, PI, and IMVD were significant predictors of the survival.
Key Words: Angiogenesis • N2 • Non-small-cell lung cancer • Proliferative activity • Stage IIIA • Surgery
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