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Ann Thorac Surg 1996;62:1021-1025
© 1996 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Skip Metastasis to the Mediastinal Lymph Nodes in Non–Small Cell Lung Cancer

Ichiro Yoshino, MD, Hideki Yokoyama, MD, Tokujiro Yano, MD, Takashi Ueda, MD, Eiji Takai, MD, Kazuki Mizutani, MD, Hiroshi Asoh, MD, Yukito Ichinose, MD

Department of Chest Surgery, National Kyushu Cancer Center, Fukuoka, Japan

Accepted for publication May 8, 1996.

Background. Whether any difference exists in clinical characteristics between resected non–small cell lung cancer with either skip or ordinary mediastinal lymph node metastases (N2 disease) needs to be clarified.

Methods. There were 110 patients with stage IIIA N2 disease. Thirty-three patients demonstrating no metastasis at the hilar nodes [skip (+) group] were compared with the other 77 patients [skip (-) group]. To investigate the extent of nodal involvement, we classified the mediastinal lymph nodes into three regions (superior, inferior, or aortic).

Results. There were no significant differences regarding histologic type, T status, or the site of the primary tumors between the skip (+) and the skip (-) N2 groups. In the skip (+) group, mediastinal node metastasis was found in only one region (level 1) in 30 patients (90.9%) and in two regions (level 2) in 3 (9.1%), whereas 28 patients (36.4%) from the skip (-) group revealed mediastinal metastasis at two or three regions (level 2 or 3). The overall survival rate at 5 years after operation was 35% in the skip (+) group and 12.7% in the skip (-) group (p = 0.054). This favorable clinical outcome in the skip (+) group could be explained partially by the higher proportion of patients with level 1 metastases. Furthermore, regarding patients with level 1 disease, the skip (+) group tended to have a better prognosis than the skip (-) group (p = 0.096).

Conclusions. These results suggest that patients with skip mediastinal lymph node metastases represent a unique subgroup of N2 disease.




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