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Impact of central location on postoperative prognosis of N2 non-small-cell lung cancer
Received:February 20, 2021  Revised:April 18, 2021  Click here to download the full text
Citation of this paper:ZHANG Kun-peng,WEN Hao-yü,GU Jie,GE Di.Impact of central location on postoperative prognosis of N2 non-small-cell lung cancer[J].Chinese Journal of Clinical Medicine,2021,28(4):544-549
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Author NameAffiliationE-mail
ZHANG Kun-peng Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China  
WEN Hao-yü Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China  
GU Jie Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China gu.jie3@zs-hospital.sh.cn 
GE Di Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ge.di@zs-hospital.sh.cn 
Abstract:Objective: To explore the impact of central location tumor on the prognosis of stage N2 non-small-cell lung cancer (NSCLC) after surgery. Methods: Clinical characteristics of 657 NSCLC patients with N2 lymph nodes metastasis, who underwent surgery at the Department of Thoracic of Zhongshan Hospital,Fudan University from January 2005 to December 2015, were retrospectively analyzed. Patients were divided into central location group (n=157) and non-central group (n=500) based on if the tumor had main bronchus invasion or obstructive pneumonia, and were analyzed through univariate and multivariate Cox regression methods with prognosis data. Results: Among the 657 patients included, the central location group had higher rate of male patients (79.0% vs 58.6%), more pneumonectomy and sleeve lobectomy (15.3% vs 0.2%, 10.2% vs 1.6%), more squamous cell carcinoma (57.3% vs 16.6%), larger tumor size (40.2 mm vs 32.9 mm), and lower rate of pleural invasion (46.5% vs 65.4%, P<0.05). The 5-year overall survival rate of central location and non-central group patients was 27.2% and 44.8%, respectively (P<0.001), age, tumor size, surgery method, N stage, chemoradiation, and central location were independent factors correlated with postoperative prognosis of patients. Hazard ratio (HR) of central location group compared to non-central group was 1.38 (P=0.016). Among the 602 patients receiving standard lobectomy, central location was also an independent risk factor associated with prognosis (HR=1.34, P=0.032). The 5-year overall survival rate of central location group was lower than non-central group patients among both squamous cell carcinoma and adenocarcinoma patients (32.7% vs 36.0%, P=0.678; 19.4% vs 48.1%, P<0.001), central location was the independent risk factor correlated with postoperative prognosis of adenocarcinoma patients (HR=2.30, 95%CI 1.51-3.50, P<0.001). Conclusions: Central location tumor is an unfavorable factor for postoperative prognosis of NSCLC patients with N2 lymph nodes metastasis. The difference is more obvious among adenocarcinoma patients, surgery decision should be more cautious for central location adenocarcinoma with N2 metastasis because of their relatively poor survival.
keywords:N2 stage  non-small-cell lung cancer  surgery  central location  prognosis
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