{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T11:19:35Z","timestamp":1777720775724,"version":"3.51.4"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T00:00:00Z","timestamp":1596067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p\/>\n                  <jats:p>The prognosis of patients with mediastinal lymph node (LN) metastasis (pN2 stage III disease) is still unsatisfactory. Both systemic and local recurrence should be prevented after curative surgery. The aim of this study was to explore the pattern of recurrence in patients with completely resected pN2 non-small-cell lung cancer (NSCLC) in the era of adjuvant chemotherapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We investigated 337 patients with completely resected cN0-1 and pN2 NSCLC from 2005 to 2016 at National Cancer Center Hospital, Japan. The patterns of recurrence were compared between patients who were managed by observation alone and those with adjuvant chemotherapy. In patients with regional LN recurrence, the pattern and site of recurrence were also explored.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>There were 195 (58.5%) men and 142 (41.5%) women with a mean age of 63.2\u2009years. Fifty-five (16.3%) patients developed only regional LN recurrence, 116 (32.6%) patients developed only distant recurrence and 65 (19.3%) patients developed both regional LN recurrence and distant recurrence. The difference in the pattern of recurrence between patients with observation alone and those with adjuvant chemotherapy was not statistically significant (P\u2009=\u20090.145). As for the pattern of regional LN recurrence, 68 (20.2%) patients had LN recurrence inside the systematic nodal dissection area.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Regional LN recurrence was observed in &amp;gt;30% of patients with completely resected pN2 NSCLC. About 20% of patients had recurrence inside the systematic nodal dissection area. Postoperative radiotherapy might be considered as an additional treatment strategy for these patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa267","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T11:22:56Z","timestamp":1593084176000},"page":"109-115","source":"Crossref","is-referenced-by-count":15,"title":["Pattern of recurrence of pN2 non-small-cell lung cancer: should postoperative radiotherapy be reconsidered?"],"prefix":"10.1093","volume":"59","author":[{"given":"Kazuo","family":"Nakagawa","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukihiro","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaya","family":"Yotsukura","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shun-ichi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,7,30]]},"reference":[{"key":"2021010414502077600_ezaa267-B1"},{"key":"2021010414502077600_ezaa267-B2","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1097\/JTO.0000000000000678","article-title":"The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer","volume":"10","author":"Asamura","year":"2015","journal-title":"J Thorac Oncol"},{"key":"2021010414502077600_ezaa267-B3","doi-asserted-by":"crossref","first-page":"3552","DOI":"10.1200\/JCO.2007.13.9030","article-title":"Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group","volume":"26","author":"Pignon","year":"2008","journal-title":"J Clin Oncol"},{"key":"2021010414502077600_ezaa267-B4","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1016\/S0140-6736(10)60059-1","article-title":"Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data","volume":"375","author":"Arriagada","year":"2010","journal-title":"Lancet"},{"key":"2021010414502077600_ezaa267-B5"},{"key":"2021010414502077600_ezaa267-B6","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S1470-2045(06)70804-X","article-title":"Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial","volume":"7","author":"Douillard","year":"2006","journal-title":"Lancet Oncol"},{"key":"2021010414502077600_ezaa267-B7","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/S0140-6736(98)06341-7","article-title":"Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials","volume":"352","year":"1998","journal-title":"Lancet"},{"key":"2021010414502077600_ezaa267-B8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cllc.2018.09.016","article-title":"Adjuvant therapy in patients with completely resected non-small-cell lung cancer: current status and perspectives","volume":"20","author":"Pirker","year":"2019","journal-title":"Clin Lung Cancer"},{"key":"2021010414502077600_ezaa267-B9","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1093\/jnci\/djg059","article-title":"Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell lung cancer","volume":"95","author":"Scagliotti","year":"2003","journal-title":"J Natl Cancer Inst"},{"key":"2021010414502077600_ezaa267-B10","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0169-5002(01)00207-0","article-title":"Overall survival and local recurrence of 406 completely resected stage IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials","volume":"34","author":"Ichinose","year":"2001","journal-title":"Lung Cancer"},{"key":"2021010414502077600_ezaa267-B11","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1016\/j.ijrobp.2013.12.048","article-title":"Patterns of local-regional failure in completely resected stage IIIA (N2) non-small cell lung cancer cases: implications for postoperative radiation therapy clinical target volume design","volume":"88","author":"Feng","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2021010414502077600_ezaa267-B12","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.lungcan.2017.11.014","article-title":"Risk factors for local recurrence after lobectomy and lymph node dissection in patients with non-small cell lung cancer: implications for adjuvant therapy","volume":"115","author":"Isaka","year":"2018","journal-title":"Lung Cancer"},{"key":"2021010414502077600_ezaa267-B13","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1093\/ejcts\/ezy063","article-title":"Prognostic factors for post-recurrence survival in patients with completely resected stage III (N2) non-small-cell lung cancer","volume":"54","author":"Cho","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021010414502077600_ezaa267-B14","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/jjco\/hyx170","article-title":"A randomized phase III trial of lobe-specific vs. systematic nodal dissection for clinical stage I-II non-small cell lung cancer (JCOG1413)","volume":"48","author":"Hishida","year":"2018","journal-title":"Jpn J Clin Oncol"},{"key":"2021010414502077600_ezaa267-B15","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/JTO.0b013e3181a0d82e","article-title":"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","volume":"4","author":"Rusch","year":"2009","journal-title":"J Thorac Oncol"},{"key":"2021010414502077600_ezaa267-B16","volume-title":"TNM Classification of Malignant Tumours 8th Edition","author":"Brierley","year":"2017"},{"key":"2021010414502077600_ezaa267-B17","first-page":"1427","volume-title":"General Thoracic Surgery","author":"Asamura","year":"2009"},{"key":"2021010414502077600_ezaa267-B18","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.athoracsur.2005.06.066","article-title":"Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial","volume":"81","author":"Allen","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2021010414502077600_ezaa267-B19","doi-asserted-by":"crossref","first-page":"e191S","DOI":"10.1378\/chest.12-2354","article-title":"The stage classification of lung cancer: diagnosis and management of lung cancer, 3rd ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines","volume":"143","author":"Detterbeck","year":"2013","journal-title":"Chest"},{"key":"2021010414502077600_ezaa267-B20","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/ejcts\/ezu028","article-title":"Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer","volume":"45","author":"De Leyn","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021010414502077600_ezaa267-B21","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1097\/JTO.0b013e3181ff9b45","article-title":"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?","volume":"6","author":"Wei","year":"2011","journal-title":"J Thorac Oncol"},{"key":"2021010414502077600_ezaa267-B22","doi-asserted-by":"crossref","first-page":"3320","DOI":"10.1200\/JCO.2013.51.1816","article-title":"Gefitinib versus placebo in completely resected non-small-cell lung cancer: results of the NCIC CTG BR19 study","volume":"31","author":"Goss","year":"2013","journal-title":"J Clin Oncol"},{"key":"2021010414502077600_ezaa267-B23","doi-asserted-by":"crossref","first-page":"4007","DOI":"10.1200\/JCO.2015.61.8918","article-title":"Adjuvant erlotinib versus placebo in patients with stage IB-IIIA non-small-cell lung cancer (RADIANT): a randomized, double-blind, phase III trial","volume":"33","author":"Kelly","year":"2015","journal-title":"J Clin Oncol"},{"key":"2021010414502077600_ezaa267-B24","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.ijrobp.2008.01.044","article-title":"Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non-small-cell lung cancer treated with adjuvant chemotherapy: the Adjuvant Navelbine international Trialist association (ANITA) randomized trial","volume":"72","author":"Douillard","year":"2008","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2021010414502077600_ezaa267-B25","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jtho.2016.09.135","article-title":"Role of postoperative radiotherapy in pathologic stage IIIA (N2) non-small cell lung cancer in a prospective nationwide oncology outcomes database","volume":"12","author":"Herskovic","year":"2017","journal-title":"J Thorac Oncol"},{"key":"2021010414502077600_ezaa267-B26","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1200\/JCO.2006.09.6263","article-title":"Need for a new trial to evaluate adjuvant postoperative radiotherapy in non-small-cell lung cancer patients with N2 mediastinal involvement","volume":"25","author":"Le P\u00e9choux","year":"2007","journal-title":"J Clin Oncol"},{"key":"2021010414502077600_ezaa267-B27"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/1\/109\/35388538\/ezaa267.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/1\/109\/35388538\/ezaa267.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T19:52:16Z","timestamp":1609789936000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/59\/1\/109\/5878241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,30]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,7,30]]},"published-print":{"date-parts":[[2021,1,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaa267","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1]]},"published":{"date-parts":[[2020,7,30]]}}}