Mediastinal lymph nodes dissection effectiveness in patients with I stage of non-small cell lung cancer

Surgical treatment of patients with lung cancer remains a debatable topic of modern oncology. The aim of our study was to investigate the effectiveness of different volumes of mediastinum lymph dissection in patients with stage I non-small cell lung cancer (NSCLC). 133 patients (113 women and 20 men) with stage I NSCLC had been being included into the study from December 2008 till January 2013. Radical surgery - lobectomy (n = 92) or pneumonectomy (n = 41) -was performed for all patients. Histological and immunohistochemical study was performed after removal of the specimen (the part of the lung, and mediastinal lymph nodes). 40 patients received adjuvant chemotherapy, 90 patients did not receive additional treatment after surgery. The period of observation of the patients was 27,1 +/- 17,2 months. Survival of patients with stage I NSCLC who underwent complete/systematic mediastinal lymph node dissection (CSMLD) during surgery was influenced by adjuvant treatment, the expression of p53, EGFR, Her-2/neu, pancytoceratine. In patients who underwent incomplete mediastinal lymph node dissection (IMLD) survival was influenced by the amount of removed lung parenchyma (lobectomy, pneumonectomy), the expression of Ki-67, p53, EGFR, Her-2/neu. Thus, performing mediastinal lymph node dissection in the volume of CSMLD improves survival in patients with stage I NSCLC during pneumonectomy, as well in overexpression of Ki-67, p53 markers. The survival rate of patients after surgical treatment with CSMLD and additional postoperative chemotherapy was worse than the long-term outcomes of patients with CSMLD without adjuvant chemotherapy (p=0.03). Further study of the issue of surgical treatment individualization for patients with early-stage NSCLC, depending on the clinical and morphological characteristics of the patient and the tumor, is necessary.