Efficacy of Mediastinal Lymph Node Dissection in Patients with Stage II Non-small Cell Lung Cancer
In the treatment of patients with non-small cell lung cancer (NSCLC) questions of the extent of resection of lung parenchyma, access to the execution of the operation, type of lymph node dissection are still debatable. The objective of our study was to analyze the efficacy of different amounts of mediastinal lymph node dissection in patients with NSCLC stage IІ.
The study was carried out from December 2008 to January 2013 on the basis of the thoracic surgery department of Zaporizhya regional Clinical oncology center. Total data of 121 patients with stage IІ non-small cell lung cancer were analyzed. Total systematic mediastinal lymph node dissection (TSMLND) was performed in 39 patients, incomplete mediastinal lymph node dissection (IMLND) —
in 82 patients. Besided routine pathomorphological study of removed specimen we have carried out immunohistochemical study of markers: Ki-67, CD31, p53, E-Cadherin, EGFR, c-erbB-2.
Results of the Study. There is a significant difference between survival rates of patients with various amount of mediastinal lymph node dissection in stage II NSCLC, indicating a statistically significant improvement in survival rate in patients with stage II NSCLC after TSMLND (p = 0.04). When tumor size ≥ 3 cm IMLND leads to a greater number of deaths from disease progression than in patients with primary tumor size < 3 cm (p = 0.04). Also carrying out pneumonectomy with IMLND worse survival rate of patients
(p = 0.001), performing of total mediastinal dissection improves the prognosis in patients with Ki-67 overexpression in the primary tumor. Similar findings are also found in patients with overexpression of Her-2/neu and EGFR (p < 0.01).
Conclusions. After TSMLND performing in patients with stage II NSCLC it was noted a statistically significant improvement in survival rate (p = 0.04). TSMLND is most effective in patients with a tumor size of ≥ 3 cm and in patients undergoing pneumonectomy. Among the morphological factors influencing the efficacy of lymph node dissection, you must select overexpression of Ki-67, EGFR and Her-2/neu. TSMLND performing in these factors significantly improves the survival of patients.
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