ArticleAnnals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia2026
Skip N2 Metastasis in Resected Lung Cancer: Prognostic Subclassification by Lymphatic Drainage and Histology.
Article in Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeSkip N2 metastasis in non-small-cell lung cancer (NSCLC) confers a favorable prognosis, yet the biological determinants remain poorly defined. We investigated lymphatic drainage patterns and histological characteristics to develop a novel pN2 subclassification.
methodsWe retrospectively analyzed 180 consecutive pN2 patients (2015-2022); 50 exhibited skip metastasis. Lymphatic drainage was classified as direct, indirect, or mixed, and a composite score incorporating drainage, histology, grade, and lymphovascular invasion stratified patients into 3 risk groups. Survival was assessed with Kaplan-Meier and Cox models.
resultsSkip metastasis was associated with superior KM-estimated 5-year overall survival compared to non-skip disease (56% vs 41%; median follow-up 43 months, with 34% of patients reaching the 5-year assessment). Direct drainage predominated in peripheral upper-lobe tumors and correlated with lower lymphovascular invasion. The model distinguished 3 prognostic groups: low-risk (5-year survival 71%), intermediate-risk (55%), and high-risk (27%). The subclassification was an independent prognostic factor, with high-risk patients showing an adjusted hazard ratio of 2.45 (95% CI 1.42-4.23).
conclusionIntegrating lymphatic drainage and histology refines prognosis in pN2 lung cancer and provides a hypothesis-generating framework for prognostic stratification of skip N2 disease, with potential to inform future clinical trial design pending validation.
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