Multimodality Therapy In Subclassified Stage Iiia-N2 Non-Small Cell Lung Cancer Patients According To The Robinson Classification: Heterogeneity And Management

Background: Non-small cell lung cancer (NSCLC) with mediastinal lymph node involvement (N2) is a heterogeneous entity. The objective of this analysis is to investigate the results of treatment strategies for N2-positive patients.Methods: Retrospective study (2009-2014) of 104 consecutive patients with stage IIIA-N2 NSCLC classified according to the Robinson classification (IILAI-IIIA4) and treated within a multimodality treatment regime.Results: The Robinson subgroups were: IIIAI (n=27), IHA3 (n=60) and IHA4 (n=17). We had no stage I I I A2 samples because we did not perform an intraoperative frozen section of lymph nodes. Surgical resection with systematic lymph node dissection was performed in all patients with stage IIIAI (n=27). After chemotherapy or chemo-/radiotherapy, 53.3% of patients in stage II IA3 (n=32) and 11.7% of patients in stage IIIA4 (n=2) underwent surgery with curative intention. RO was achieved in 92.6% in stage IIIAI, 93.8% in stage IIIA3 and 100% in stage HIA4. The 30-day mortality was 3.2%. The overall median survival was 31.7 months (5-year survival was 30.5%). There were no significant differences (P=0.583) in survival regarding the Robinson subgroups. Patients who underwent tumour resection had significantly better median survival (39.8 vs. 19.6 months; P=0.014) compared to patients treated conservatively. Deviation from the interdisciplinary recommended therapy (12%) led to a reduced median survival (11.4 vs. 31.8 months; P=0.137).Conclusions: N2-patients should be subclassified according to the Robinson classification and discussed in the tumour board. Surgical resection should be recommended in specific cases of N2-disease (non-bulky, sensitivity to systemic treatment).