Prognostic Multivariate Analysis Of Multimodality Treatment Dominated By Surgery For Stage ?A-N2 Non-small Cell Lung Cancer

Objective: Stage ?A-N2 non-small cell lung cancer is a subgroup of locally advanced non-small cell lung cancer with significant heterogeneity.At present,there are still controversies about its best treatment plan.With the development of modern medicine,surgical techniques have matured and stage ?A-N2 non-small cell lung cancer has not been considered as a taboo like the past.However,the prognosis of patients undergoing surgical treatment is still not ideal,therefore,it is necessary to clarify which factors affect the survival status of patients with stage ?A-N2 NSCLC after surgery.This article retrospectively analyzed the survival status of 110 patients with stage ?A-N2 non-small cell lung cancer after thoracic surgery in our hospital,and explored the factors affecting the postoperative survival of patients with stage ?A-N2 non-small cell lung cancer.Methods: The clinicopathological data of patients who underwent curative resection from October 2006 to October 2016 in the Department of Thoracic Surgery,the First Affiliated Hospital of Bengbu Medical College and pathologically diagnosed as stage ?A-N2 were reviewed retrospectively.A total of 110 patients who met the admission criteria were included in the whole group,some of them received neoadjuvant therapy before surgery,all cases were treated with anatomical lobectomy or pneumonectomy combined with systemic lymph node dissection,supplemented with platinum-based chemotherapy and/or radiotherapy.The median survival time and 1,3,and 5-year survival rates of the whole group were analyzed.Univariate and multivariate analyses were performed on the following factors of the study subjects,including gender,age,pathological type,operation modes,T stage,preoperative and postoperative adjuvant treatment,number of N2 lymph node metastases,and trans-regional MLN metastases,etc.Result: 1.The median survival time of the whole study group was 36.0 months,and the 1,3,and 5-year survival rates were 83.6%,41.8%,and 22.7%,respectively.2.Univariate analysis shown:The 1,3,and 5-year survival rates of patients with single-station N2 lymph node metastases were 85.5%,50.7%,and 30.4%,which were significantly better than those of multi-station N2 lymph node metastasis(75.6%,34.1%,and 17.1%)(P=0.042);The 1,3,and 5-year survival rates of non-regional lymph node metastases were 89.2%,47.3%,and 27.0%,which were significantly better than those of trans-regional MLN metastases(83.3%,22.2%,and 11.1%)(P=0.004);The 1,3and 5-year survival rates of patients who received at least 4 cycles of postoperative adjuvant chemotherapy were 92.6%,52.9%,and 26.5%,which were significantly better than patients who received chemotherapy for less than 4 cycles(81.0%,23.8%,and 14.3%)(P=0.03).The other factors mentioned above are not significantly related to the prognosis of the patient.3.Multivariate analysis suggested that multi-station N2 lymph node metastasis(P=0.009)and trans-regional MLN metastases(P=0.046)were independent risk factors of those patients.Conclusion: 1.The overall survival of patients with stage ?A-N2 NSCLC is unsatisfactory,and the patient's survival rate continues to decline.There is still much work to be done to improve the postoperative survival rate of patients.2.Multi-station lymph node metastasis and trans-regional metastasis are risk factors affecting the prognosis of patients in this stage.It is of certain clinical value to perform selective surgery and systematic mediastinal lymph node dissection for patients with stage ?A-N2 NSCLC.