Nodal status at repeat mediastinoscopy determines survival in non-small cell lung cancer with mediastinal nodal involvement, treated by induction therapy☆

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Abstract
Objective: Remediastinoscopy is a valuable tool in restaging non-small cell lung cancer after induction therapy for mediastinal nodal involvement as it provides pathological evidence of response and may select patients for subsequent thoracotomy. However, long-term survival data after remediastinoscopy are scarce. Methods: From November 1994 to April 2003, a remediastinoscopy was performed in 32 patients (29 men, 3 women) after induction therapy for locally advanced non-small cell lung cancer. Mean age was 67.8 years (range, 47–83). Neoadjuvant chemotherapy was given in 26 patients and chemoradiotherapy in 6. Follow-up data were completed in January 2005. Results: Remediastinoscopy was technically feasible in all patients. There were five false-negative remediastinoscopies, resulting in a sensitivity of 71%, specificity of 100% and accuracy of 84%. Follow-up was complete in all patients. Median survival time for the whole group was 21 months (95% confidence interval [CI] 9–33). Median survival time in patients with a positive remediastinoscopy was 7 months (95% CI 5–9), with a negative remediastinoscopy 41 months (95% CI 13–69), and with a false-negative remediastinoscopy 24 months (95% CI 5–43). The difference between positive and negative remediastinoscopies was highly significant (p = 0.003). In the combined group of patients with positive and false-negative remediastinoscopies (n = 17), median survival time was 8 months (95% CI 3–13). The difference with negative remediastinoscopy remained significant (p = 0.012). In a multivariate analysis, including sex, age, histology and nodal status at repeat mediastinoscopy, only nodal status was a significant independent prognostic factor (p = 0.015). Conclusions: Remediastinoscopy is a valuable restaging procedure after induction therapy. Prognosis is poor in patients with persisting mediastinal nodal involvement, proven at repeat mediastinoscopy.

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