Prognostic analysis of surgical‑pathologic N1 disease in non‑small cell lung cancer: Single‑center experience with 276 cases

OBJECTIVE: Patients who receive surgical treatment due to non‑small cell lung cancer (NSCLC) and have surgical‑pathologic N1 (pN1) disease represent a heterogeneous group. Differences in lymph node (LN) level (hilar or intrapulmonary LNs) may influence patient survival. The aim of this study was to evaluate the prognostic factors, including the level of N1 LN involvement.
METHODS: Patients undergoing complete resection at a single center between January 2000 and January 2017 and diagnosed with surgical‑pN1 NSCLC were analyzed retrospectively. Patients were examined in terms of demographic characteristics, preoperative and postoperative management, survival rates, as well as variables affecting survival.
RESULTS: The mean follow‑up duration was 50.9 ± 41.2 months (between 2.7 and 204 months); median and 5‑year survival rates were 71.5 months and 53.7%, respectively. Five‑year survival rates of patients aged 60 and below (n = 144) and patients over the age of 60 (n = 132) were 59.7% and 46.9%, respectively (P = 0.001). Five‑year survival rates for patients receiving and not receiving adjuvant therapy were 58.4% and 45.3%, respectively (P = 0.02). When surgical‑pN1 involvement was assessed with regard to localization, 5‑year survival was 59.1% in hilar involvement, 52.4% in intrapulmonary involvement, and 49.4% in involvement of both zones at the same time (P = 0.58). In Cox regression analysis, variables affecting survival were age group and adjuvant therapy (P = 0.001 and P = 0.012, respectively).
CONCLUSION: Surgical‑pN1 localization or pleural involvement does not have a significant effect on survival, whereas advanced age and further T classification affect survival adversely. Adjuvant therapy, on the other hand, has a significantly positive effect on survival.