Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Significance of the Aortic Node in Non-small Cell Lung Cancer of the Left Upper Lobe

좌상엽에 발생한 비소세포형 폐암에서 Aortic Node의 의의

  • 김대준 (연세대학교 의과대학 흉부외과학교실) ;
  • 김길동 (연세대학교 의과대학 흉부외과학교실) ;
  • 이기종 (연세대학교 의과대학 흉부외과학교실) ;
  • 정경영 (연세대학교 의과대학 흉부외과학교실)
  • Published : 2003.11.01
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Abstract

Background: To clarify the clinical significance of the aortic nodes in resected non-small cell lung cancer of the left upper lobe. Material and Method: One hundred fifty six patients with resected non-small cell lung cancer of the left upper lobe were studied. Patients who received preoperative induction therapy, non-curative operation or defined as operative mortality were excluded from this study. Result: In N2 left upper lobe tumors, aortic nodes comprised 52.7% of the metastatic mediastinal lymph nodes. In single station N2 disease, a frequently metastasized station was aortic node (64.3%). 5-year actuarial survival according to the N status was 65.0% in N0, 30.4% in N1, and 17.9% in N2. There was no statistically significant difference in survival between N1 and N2 diseases (p=0.06). The patients with metastasis to aortic node alone had a comparatively good prognosis (5-year survival: 35.6%) than other N2 diseases (5-year survival: 4.6%) (p=0.01) and had a similar survival outcome as N1 diseases (p=0.97). Considering the aortic node as N1 node, 5-year survival according to the N status was 65.0% in N0, 31.2% in N1, 4.6% in N2 and significant survival difference was observed between N1 and N2 disease (p=0.00). In multivariate analysis, the male sex (hazard ratio 6.892, p=0.011) and the involvement to the aortic node alone (hazards ratio 2.799, p=0.009) were the significant factors affecting postoperative survival. Conclusion: According to the our data, involvement to the aortic node alone in left upper lobe tumors should be grouped with N1 disease because this combined category reflects the surgical outcome more accurately.

배경: 좌상엽에 발생한 비소세포형 폐암에서 aortic node전이 양상에 따른 생존율을 분석하여 임상적 의의를 알아보고자 하였다. 대상 및 방법: 1991년 1월부터 2000년 12월까지 좌상엽에 발생한 비소세포형 폐암으로 페엽절제술 이상의 수술을 받은 환자 중 수술 전 항암 화학요법 또는 방사선 치료를 받은 환자와 수술 사망 환자를 제외한 156명을 대상으로 후향적 연구를 하였다. 결과: 종격동임파절 전이 중 aortic node로의 전이는 52.7%였으며, 단일 부위(single station) 전이 중 aortic node로만 전이된 경우는 64.3%였다. N 병기에 따른 5년 생존율은 N0 65.0%, Nl 30.4%, N2 17.9%였으며, Nl 병기와 N2 병기 간에는 생존율의 차이를 관찰할 수 없었다(p=0.06). N2 병기 중 aortic node에만 전이된 경우 5년 생존율 35.6%로 다른 종격동임파절에 전이된 경우(5년 생존율 4.6%)보다 생존율이 높았으며 (p=0.01), Nl 병기와 비교 시 비슷한 생존율을 보였다(p=0.97). Aortic node를 Nl 임파절로 재분류하였을 때 N 병기별 5년 생존율은 N0 65.0%, Nl 11.2%, N2 4.6%로 Nl 병기와 N2 병기 간에 뚜렷한 생존율의 차이를 관찰할 수 있었다(p=0.00). 다변량 분석 시 aortic node에만 전이된 경우(hazard ratio 2.799, p=0.009), 남자(hazard ratio 6.892, p=0.011)가 술 후 생존에 영향을 미치는 의미있는 인자였다. 결론: 좌상엽 종양에서 aortic node에만 전이된 경우 외과적 절제 시 Nl 병기와 비슷한 생존율을 가지며, 따라서 치료 방침의 결정 시 이를 Nl 임파절로 간주하는 것이 타당하다고 생각한다.

Keywords

References

  1. J Thorac Cardivasc Surgery v.118 Prognosis of completely resected pN2 non-small cell lung carcinomas: what is the significant node that affects survival? Okada,M.;Tsubota,N.;Yoshimura,M.;Miyamoto,Y.;Matsuoka,H. https://doi.org/10.1016/S0022-5223(99)70217-5
  2. J Thorac Cardiovasc Surg v.122 Completely resected stage ⅢA non-small cell lung cancer: The significance of primary tumor location and N2 station Ichinose,Y.;Kato,H.;Koike,T.(et al.) https://doi.org/10.1067/mtc.2001.116473
  3. Ann Thorac Surg v.43 Significance of metastatic disease in subaortic lymph nodes Patterson,G.A.;Piazza,O.;Pearson,F.G.(et al.) https://doi.org/10.1016/S0003-4975(10)60386-4
  4. Ann Thorac Surg v.57 Results of surgical resection in patients with N2 non-small cell lung cancer Miller,D.L.;McManus,K.G.;Allen,M.S.(et al.) https://doi.org/10.1016/0003-4975(94)91335-8
  5. J Thorac Cardiovasc Surg v.76 Lymph node mapping and curability at various levels of metastasis in resected lung cancer Naruke,T.;Suematsu,K.;Ishikawa,S.(et al.)
  6. J Am Stat Assoc v.53 Non-parametric estimation from incomplete observations Kaplan,E.;Meier,P. https://doi.org/10.2307/2281868
  7. J R Stat Soc v.34 Regression models and life tables Cox,D.W.
  8. The spread of carcinoma of bronchus Nohl,H.C.
  9. Sur Clin North Am v.67 The role of surgery in N2 Lung cancer Martini,N.;Flehinger,B.J. https://doi.org/10.1016/S0039-6109(16)44341-0
  10. Diagnosis and treatment of lung cancer. An evidence-based guide for the practicing clinician(1st ed.) Detterbeck,F.C.;Mark,A.S.;Rivera,M.P.(et al.)