Annals of Surgical Oncology

, Volume 20, Issue 7, pp 2413–2418 | Cite as

Survival of Patients with Non-Small Cell Lung Cancer According to Lymph Node Disease: Single pN1 vs Multiple pN1 vs Single Unsuspected pN2

  • Ivan Macia
  • Ricard Ramos
  • Juan Moya
  • Francisco Rivas
  • Anna Ureña
  • Marta Banque
  • Ignacio Escobar
  • Gabriela Rosado
  • Pau Rodriguez-Taboada
Thoracic Oncology



This study was designed to describe the characteristics and survival of NSCLC patients treated with surgery and single pN1 disease, multiple pN1, and single unsuspected pN2.


In 2005–2009, we treated 378 lung cancer patients with surgery with radical intent; 152 cases were pN1 or pN2. We excluded patients with neoadjuvant treatment, incomplete resection, incomplete lymph node dissection, metastasis, cN2 disease, multiple pN2, SCLC, and lack of PET-CT. All patients were staged with TNM 2010. We included 72 patients: 21 single pN1, 26 multiple pN1, and 25 single unsuspected pN2. Statistical analysis included descriptive statistics, chi-square test, Kaplan–Meier, log-rank test, and Cox proportional hazard model.


The sample included 62 men (86 %) and 10 women (14 %), mean age 64 ± 9 years. The three subgroups did not show statistically significant differences in the main characteristics. Adjuvant treatment was performed in 56 patients (78 %). The 5 year overall survival (OS) for single pN1 was 73 %; for multiple pN1, 34 %; and for single unsuspected pN2, 25 % (P = 0.15). The mean OS for single pN1 was 63 ± 6 months; median OS for multiple pN1 was 45 (range, 42–48) months and for single pN2 was 54 (range, 32–77) months. Multivariate analysis found the following negative prognostic factors of OS: for single pN1, age, female sex, and microscopic intratumoral lymphatic and vascular invasion; for multiple pN1, ≤10 lymph nodes resected.


Patients with single pN1 had better OS than patients with multiple pN1. Patients with single unsuspected pN2 had OS similar to that of multiple pN1.


Overall Survival Median Overall Survival Resected Lymph Node Lymph Node Disease Lymph Node Zone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank Editorial Rx, Inc. for their help revising the text and the Spanish Society of Pulmonology and Thoracic Surgery for their help funding the text editing. This study did not receive any funding.

Conflict of interest

This study did not have any commercial interest.

Supplementary material

10434_2012_2865_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 32 kb)
10434_2012_2865_MOESM2_ESM.tif (1.3 mb)
Supplementary material 2 (TIFF 1313 kb)


  1. 1.
    Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg. 2008;86:912–20.PubMedCrossRefGoogle Scholar
  2. 2.
    Robinson LA, Ruckdeschel JC, Wagner H, Stevens CW. Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edn). Chest. 2007;132:243S–65S.PubMedCrossRefGoogle Scholar
  3. 3.
    Wei S, Asamura H, Kawachi R, Sakurai H, Watanabe S. Which is the better prognostic factor for resected non-small cell lung cancer. The number of metastatic lymph nodes or the currently used nodal stage classification? J Thorac Oncol. 2011;6:310–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P. The IASLC lung cancer staging project. A proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:568–77.PubMedCrossRefGoogle Scholar
  5. 5.
    Macia I, Moya J, Escobar I, et al. Quality study of a lung cancer committee: study of agreement between preoperative and pathological staging. Eur J Cardiothorac Surg. 2010;37:540–5.PubMedCrossRefGoogle Scholar
  6. 6.
    De Leyn P, Lardinois D, Van Schil P, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg. 2007;32:1–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg. 2006;30:787–92.PubMedCrossRefGoogle Scholar
  8. 8.
    Lee JG, Lee CY, Park IK, Kim DJ, Park SY, Kim KD, Chung KY. Number of metastatic lymph nodes in resected non-small cell lung cancer predicts patient survival. Ann Thorac Surg. 2008;85:211–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Fukui T, Mori S, Yokoi K, Mitsudomi T. Significance of the number of positive lymph nodes in resected non-small cell lung cancer. J Thorac Oncol. 2006;1:120–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Kang CH, Ra TJ, Kim YT, Jheon SH, Sung SW, Kim JH. The impact of multiple metastatic nodal stations on survival in patients with resectable N1 and N2 nonsmall-cell lung cancer. Ann Thorac Surg. 2008;86:1092–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Rusch VW, Crowley J, Giroux DJ, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:603–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Asamura H, Suzuki K, Kondo H, Tsuchiya R. Where is the boundary between N1 and N2 stations in lung cancer? Ann Thorac Surg. 2000;70:1839–46.PubMedCrossRefGoogle Scholar
  13. 13.
    Riquet M, Manac’h D, Le Pimpec-Barthes F, Dujon A, Chehab A. Prognostic significance of surgical-pathologic N1 disease in non-small cell carcinoma of the lung. Ann Thorac Surg. 1999;67:1572–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Fujimoto T, Cassivi SD, Yang P, et al. Completely resected N1 non-small cell lung cancer: factors affecting recurrence and long-term survival. J Thorac Cardiovasc Surg. 2006;132:499–506.PubMedCrossRefGoogle Scholar
  15. 15.
    Martini N, Burt ME, Bains MJ, McCormack PM, Rusch VW, Ginsberg RJ. Survival after resection of stage II non-small cell lung cancer. Ann Thorac Surg. 1992;54:460–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Osaki T, Nagashima A, Yoshimatsu T, Tashima Y, Yasumoto K. Survival and characteristics of lymph node involvement in patients with N1 non-small cell lung cancer. Lung Cancer. 2004;43:151–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Demir A, Turna A, Kocaturk C, et al. Prognostic significance of surgical-pathologic N1 lymph node involvement in non-small cell lung cancer. Ann Thorac Surg. 2009;87:1014–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Lee JG, Lee CY, Bae MK, Park IK, Kim DJ, Kim KD, Chung KY. Validity of International association for the study of lung cancer proposals for the revision of N descriptors in lung cancer. J Thorac Oncol. 2008;3:1421–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Higgins KA, Chino JP, Ready N, et al. Lymphovascular invasion in non-small-cell lung cancer. Implications for staging and adjuvant therapy. J Thorac Oncol. 2012;7:1141–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Sawyer TE, Bonner JA, Gould PM, Foote RL, Deschamps C, Lange CM, Li H. Factors predicting patterns of recurrence after resection of N1 non-small cell lung carcinoma. Ann Thorac Surg. 1999;68:1171–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J, International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350:351–60.PubMedCrossRefGoogle Scholar
  22. 22.
    Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26:3552–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Andre F, Grunenwald D, Pignon JP, et al. Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol. 2000;18:2981–9.PubMedGoogle Scholar
  24. 24.
    Detterbeck F. What to do with “surprise” N2? Intraoperative management of patients with non-small cell lung cancer. J Thorac Oncol. 2008;3:289–302.PubMedCrossRefGoogle Scholar
  25. 25.
    Riquet M, Bagan P, Le Pimpec Barthes F, et al. Completely resected non-small cell lung cancer: reconsidering prognostic value and significance of N2 metastases. Ann Thorac Surg. 2007;84:1818–24.PubMedCrossRefGoogle Scholar
  26. 26.
    Zheng H, Wang L, Bao F, et al. Re-appraisal of N2 disease by lymphatic drainage pattern for non-small-cell lung cancers: by terms of nodal stations, zones, chains and a composite. Lung Cancer. 2011;74:497–503.PubMedCrossRefGoogle Scholar
  27. 27.
    Riquet M, Manac’h D, Saab M, Le Pimpec-Barthes F, Dujon A, Debesse B. Factors determining survival in resected N2 lung cancer. Eur J Cardiothorac Surg. 1995;9:300–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Kim MS, Lee HS, Lee JM, Zo JI, Lee GK, Nam BH. Prognostic value of single nodal zone metastasis in non-small cell lung cancer. Eur J Cardiothorac Surg. 2010;38:491–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Keller SM, Vangel MG, Wagner H, et al. Prolonged survival in patients with resected non-small cell lung cancer and single-level N2 disease. J Thorac Cardiovasc Surg. 2004;128:130–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Misthos P, Sepsas E, Kokotsakis J, Skottis I, Lioulias A. The significance of one-station N2 disease in the prognosis of patients with nonsmall-cell lung cancer. Ann Thorac Surg. 2008;86:1626–31.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Ivan Macia
    • 1
  • Ricard Ramos
    • 1
  • Juan Moya
    • 1
  • Francisco Rivas
    • 2
  • Anna Ureña
    • 2
  • Marta Banque
    • 3
  • Ignacio Escobar
    • 1
  • Gabriela Rosado
    • 2
  • Pau Rodriguez-Taboada
    • 2
  1. 1.Department of Thoracic Surgery and University of BarcelonaHospital Universitari de Bellvitge, L’Hospitalet de LlobregatBarcelonaSpain
  2. 2.Department of Thoracic SurgeryHospital Universitari de Bellvitge, L’Hospitalet de LlobregatBarcelonaSpain
  3. 3.Department of Preventive MedicineHospital Universitari de Bellvitge, L’Hospitalet de LlobregatBarcelonaSpain

Personalised recommendations