Evaluation of mediastinal lymph node metastasis and prognostic factors in patients with pN2 non-small cell lung cancer

We evaluated mediastinal lymph node metastasis and prognostic factors in ninety pN2 non-small cell lung cancers. The most frequent location of node metastasis associated with tumor affecting the upper lobe was the superior mediastinum (from rt. upper lobe ; 97.0 %, lt. upper lobe ; 63.2 %). The most common location of node metastasis associated with tumor affecting the lower lobe was subcarinal lymph node (from rt. lower lobe ; 75.9 %, lt. lower lobe ; 62.5 %). However, superior mediastinal metastasis was often found with tumor affecting the lower lobe (from rt. lower lobe ; 65.5 %, lt. lower lobe ; 50.0 %), and subcarinal lymph node metastasis was also found with tumor affecting the upper lobe (from rt. upper lobe ; 18.2 %, it. upper lobe ; 36.8 %) (distant node metastasis). The 5-year survival rate of all subjects except patients underwent absolute non-curative operation was 19.8 %. Because the distant node metastasis is found with considerable frequency, complete mediastinal dissection should be recommended as curative resection for non-small cell lung cancer. This study revealed that the presence of 5 or more metastatic mediastinal lymph nodes, cN2, pT3 and pT4 were the poor prognostic factors in the patients with pN2 lung cancer. Especially pN2 patients with pT4 or who concurrently have two or more poor prognostic factors should be excluded from the indication for curative operation.