Objectives : Remediastinoscopy (reMS) is a valuable tool in restaging non-small cell lung cancer (NSCLC) after induction therapy for mediastinal nodal involvement as it provides pathological evidence of response. However, long-term survival data after reMS are scarce.
Methods : From November 1994 to April 2003, a reMS was performed in 32 pts (29 men, 3 women) after induction therapy for locally advanced NSCLC. Mean age was 67.8 years (range 47-83). Follow-up data were completed in January 2005. A Kaplan-Meier survival analysis was performed. By uni- and multivariate analysis significant prognostic factors in relation to survival were determined.
Results : reMS was technically feasible in all pts. reMS was positive in 12 pts and negative in 20; the latter group underwent thoracotomy. There were 5 false negative reMS. Sensitivity of reMS was 71 %, specificity 100 % and accuracy 84 %. Follow-up was complete in all patients. During follow-up 21 pts died, mostly of distant metastases. Median survival time (MST) for the whole group was 23 months (95% confidence interval [CI] 6-40). MST in pts with a positive reMS was 7 months (95% CI 5-9), with a negative reMS 41 months (95% CI 13-69) and with a false negative reMS 24 months (95% CI 0-57). In univariate analysis the difference between positive and negative reMS was highly significant (p=0.003). In the combined group of pts with positive and false negative reMS (n=17) MST was 8 months (95% CI 0-22). In univariate analysis the difference with negative reMS remained significant (p=0.012). In a forward stepwise multivariate analysis including sex, age, histology and nodal status at reMS, only nodal status was a significant independent prognostic factor (p=0.015). Relative risk in pts with positive reMS was 2.88.
Conclusions : reMS is a valuable restaging procedure after induction therapy. Prognosis is poor in pts with persisting mediastinal nodal involvement proven at reMS.