Long-term survival and local lymph node recurrence

Between 1997 and 2004, 463 patients underwent video-assisted thoracoscopic lung resection for early stage non-small cell lung cancer. The median follow-up duration was 59.3 months. Overall survival at 5 and 10 years was 85.7% and 72.7%, respectively, while disease-free survival was 77.0% and 66.9%, respectively. During follow-up, 87 patients (18.8%) had recurrence. Forty-four patients (9.5%) had local recurrence and 74 (16.0%) had distant recurrence. Multivariate logistic regression analysis showed that clinical T-factor (odds ratio, 2.98: 95% confidence interval, 1.15-7.76: p = 0.0024) and pathological N-positive status, equivalent to nodal upstaging, (odds ratio, 8.53; 95% confidence interval, 3.26-22.52: p < 0.001) were associated with an increased risk for local lymph node recurrence. The accuracy of nodal staging depends on the number of lymph nodes removed and nodal upstage. Therefore, to prevent local lymph node recurrence, maintenance of the number of lymph nodes removed and nodal upstage is required.