Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Outcomes of the Initial Surgical Treatment without Neoadjuvant Therapy in Patients with Unexpected N2 Non-small Cell Lung Cancer

선행요법 없이 초기치료로서 수술을 시행했던 예측되지 않은 N2 비소세포폐암의 치료 성적

  • Shim, Man-Shik (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jhin-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoon, Yoo-Sang (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Sung-Wook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Hong-Kwan (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Yong-Soo (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kwhan-Mien (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shim, Young-Mog (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 심만식 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 김진국 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 윤유상 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 장성욱 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 김홍관 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 최용수 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 김관민 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실) ;
  • 심영목 (성균관대학교 의과대학 삼성서울병원 흉부외과학교실)
  • Received : 2009.08.13
  • Accepted : 2009.10.20
  • Published : 2010.02.05
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Abstract

Background: Preoperative chemotherapy has been adopted in our hospital as a standard treatment for non-small cell lung cancer patients with N2 disease. However, there have been cases of pathologic N2 disease that have been detected after curative-intent surgical resection. We retrospectively studied the outcomes of initial surgical treatment without neoadjuvant therapy in patients with unexpected N2 non-small cell lung cancer. Material and Method: Between January 1995 and June 2007, 225 patients were diagnosed with pathologic N2 disease after they underwent initial pulmonary resection without neoadjuvant therapy. Among them, 170 patients were preoperatively diagnosed with lymph node stage N0 or N1. We retrospectively reviewed their medical record and analyzed the outcomes. Result: The overall 5-year survival rate was 35.4%. The prognostic factors that were significantly associated with survival were no adjuvant therapy, histologic cell types other than adenocarcinoma or squamous cell carcinoma, a pathologic T stage more than T1, old age (${\geq}$70 years) and no mediastinoscopic biopsy. During the follow-up, 79 patients (46.5%) experienced tumor recurrence, including loco-regional recurrence in 20 patients (25.3%) and distant metastasis in 56 (70.9%). The 5-year recurrence-free survival rate was 33.7%. Conclusion: Based on our findings, the survival was good for patients with unexpected N2 non-small cell lung cancer and who underwent initial pulmonary resection without neoadjuvant therapy. A prospective comparative analysis is needed to obtain more conclusive and persuasive results.

배경: 수술 전 항암요법은 원발 종양과 같은 쪽 종격동 또는 기관용골하 림프절전이가 있는 비소세포 폐암(N2 질환)에 대한 치료로서 본원의 치료방침으로 사용 중이나, 병기결정을 위한 검사들의 위음성(false-negative)으로 인해 선행요법 없이 수술한 뒤 병리학적으로 N2 질환으로 진단되는 경우가 있다. 이에 초기 치료로서 수술을 시행했던 예측되지 않은 N2 비소세포폐암 치료의 성적을 후향적으로 분석하였다. 대상 및 방법: 1995년 1월부터 2007년 6월까지 비소세포폐암으로 진단받고 초기 치료로서 폐절제술을 시행한 뒤 병리학적 N2로 확인된 225명의 환자들 중 술 전 림프절 병기가 N0 또는 N1이었던 170명의 환자들 연구 대상하여 의무기록을 후향적으로 분석하여 생존율과 무재발 생존율 및 재발양상을 분석하였으며 생존율에 관계된 예후인자에 대하여 조사하였다. 결과: 5년 전체 생존율 (overall survival rate)은 35.4%였고, 중앙 생존 기간(median survival time)은 31개월이었다. 생존율에 영향을 미치는 인자로서 술 후 보조요법을 받지 않은 경우, 조직학적 유형이 선암이나 편평상피세포암이 아닌 경우, 병리학적 T 병기가 T2 이상인 경우, 70세 이상의 고령, 술 전 종격동내시경을 시행하지 않은 경우에 예후가 더 불량한 것으로 나타났다. 경과 관찰 중 79명(46.5%)에서 재발이 확인되었고 이중 20명(25.3%)은 국소재발이었고 56명(70.9%)은 원격전이로 재발하였다. 5년 무재발 생존율은 33.7%였다. 결론: 본 연구에서는 초기 치료로서 수술을 시행했던 예측되지 않은 N2 비소세포폐암 환자들의 생존율에 있어 비교적 좋은 성적을 보이고 있다. 하지만 보다 설득력 있는 결과를 위해서는 전향적 비교분석 연구가 필요하다.

Keywords

References

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