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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2020

01-02-2020 | NSCLC | Thoracic Oncology

Lobe-Specific Lymph Node Dissection for Clinical Early-Stage (cIA) Peripheral Non-small Cell Lung Cancer Patients: What and How?

Authors: Han-Yu Deng, MD, Jie Zhou, MD, Ru-Lan Wang, MD, Rui Jiang, MD, Da-Xing Zhu, MD, Xiao-Jun Tang, MD, Qinghua Zhou, MD

Published in: Annals of Surgical Oncology | Issue 2/2020

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Abstract

Objective

We investigated the possible lobe-specific lymph node (LN) metastasis pattern of early-stage peripheral non-small cell lung cancers (NSCLC) and define the extent of lobe-specific LN dissection for them.

Methods

We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic lymphadenectomy for clinical T1N0M0 peripheral NSCLC from January 2015 to December 2018. The LN metastasis pattern was analyzed by tumor lobe location.

Results

A total of 590 patients were included for analysis. The mean number of total dissected LNs was 12.3 ± 5.8 and 8.2 ± 4.1 for total dissected mediastinal LNs. The rate of mediastinal LN metastasis was 9.5%. For cases of upper lobe tumor and lower lobe tumor, 8.8% and 6.0% of them respectively metastasized to the upper LN zone (P = 0.274). However, upper lobe tumors hardly metastasized to the subcarinal (0.3%) and lower (0.3%) LN zones while for lower lobe tumors, the rate of LN metastasis was 10.2% and 5.4% respectively (both P < 0.001). However, all cases (100%) metastasizing from lower lobes to the upper LN zone had a tumor size of 2–3 cm, whereas cases with a tumor size ≤ 2 cm had no metastasis (0%). None of the tumors in the right middle lobe metastasized to the lower LN zone (0%).

Conclusions

A lobe-specific LN metastasis pattern was observed in clinical stage IA peripheral NSCLC. For tumors in upper lobes (≤ 3 cm), there may be no need to dissect lower mediastinal LNs and for tumors in lower lobes (≤ 2 cm), dissecting upper mediastinal LNs may not be required.
Appendix
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Literature
1.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.CrossRef
2.
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115–32.CrossRef
3.
Gadgeel SM, Ramalingam SS, Kalemkerian GP. Treatment of lung cancer. Radiol Clin North Am. 2012;50(5):961–74.CrossRef
4.
Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.CrossRef
5.
Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd edn: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl.):e278S–313S.CrossRef
6.
Okada M, Tsubota N, Yoshimura M, Miyamoto Y. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas: role of subcarinal nodes in selective dissection. J Thorac Cardiovasc Surg. 1998;116(6):949–53.CrossRef
7.
Asamura H, Nakayama H, Kondo H, Tsuchiya R, Naruke T. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg. 1999;117(6):1102–11.CrossRef
8.
Deng HY, Qin CL, Li G, et al. Can lobe-specific lymph node dissection be an alternative to systematic lymph node dissection in treating early-stage non-small cell lung cancer: a comprehensive systematic review and meta-analysis? J Thorac Dis. 2018;10(5):2857–65.CrossRef
9.
Han H, Chen H. Selective lymph node dissection in early-stage non-small cell lung cancer. J Thorac Dis. 2017;9(7):2102–7.CrossRef
10.
Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardio Thoracic Surg. 2006;30(5):787–92.CrossRef
11.
Casal RF, Vial MR, Miller R, et al. What exactly is a centrally located lung tumor? Results of an online survey. Ann Am Thorac Soc. 2017;14(1):118–23.CrossRef
12.
Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol. 2011;6(2):244–85.CrossRef
13.
Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39–51.CrossRef
14.
Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P. 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. J Thorac Oncol. 2009;4(5):568–77.CrossRef
15.
Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26:404–13.CrossRef
16.
Ma W, Zhang ZJ, Li Y, Ma GY, Zhang L. Comparison of lobe-specific mediastinal lymphadenectomy versus systematic mediastinal lymphadenectomy for clinical stage T(1)a N(0) M(0) non-small cell lung cancer. J Cancer Res Therapeut. 2013;9 Suppl 2:S101–5.
17.
Kim AW. Lymph node drainage patterns and micrometastasis in lung cancer. Sem Thorac Cardiovasc Surg. 2009;21(4):298–308.CrossRef
18.
Watanabe Y, Shimizu J, Tsubota M, Iwa T. Mediastinal spread of metastatic lymph nodes in bronchogenic carcinoma. Mediastinal nodal metastases in lung cancer. Chest. 1990;97(5):1059–65.CrossRef
19.
Riquet M, Rivera C, Pricopi C, et al. Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal. Eur J Cardio Thorac Surg. 2015;47(3):543–9.CrossRef
20.
Liang RB, Yang J, Zeng TS, et al. Incidence and distribution of lobe-specific mediastinal lymph node metastasis in non-small cell lung cancer: data from 4511 resected cases. Ann Surg Oncol. 2018;25(11):3300–7.CrossRef
21.
Xu ZQ, Xie LJ, Fan W, Duan XB, Cheng MH. Risk factors for mediastinal lymph node metastasis in non-small-cell lung cancer by PET/CT. Nucl Med Comm. 2014;35(5):466–71.CrossRef
22.
Asamura H, Nakayama H, Kondo H, Tsuchiya R, Shimosato Y, Naruke T. Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy? J Thorac Cardiovasc Surg. 1996;111(6):1125–34.CrossRef
23.
Oda M, Watanabe Y, Shimizu J, et al. Extent of mediastinal node metastasis in clinical stage I non-small-cell lung cancer: the role of systematic nodal dissection. Lung cancer (Amsterdam, Netherlands). 1998;22(1):23–30.CrossRef
24.
Turna A, Solak O, Kilicgun A, Metin M, Sayar A, Gurses A. Is lobe-specific lymph node dissection appropriate in lung cancer patients undergoing routine mediastinoscopy? Thorac Cardiovasc Surg. 2007;55(2):112–9.CrossRef
25.
Aokage K, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer (Amsterdam, Netherlands). 2010;70(2):163–7.CrossRef
26.
Yang MZ, Hou X, Liang RB, et al. The incidence and distribution of mediastinal lymph node metastasis and its impact on survival in patients with non-small-cell lung cancers 3 cm or less: data from 2292 cases. Eur J Cardio Thorac Surg. Jan 18 2019.
27.
Gould MK, Kuschner WG, Rydzak CE, et al. Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med. 2003;139(11):879–92.CrossRef
Metadata
Title
Lobe-Specific Lymph Node Dissection for Clinical Early-Stage (cIA) Peripheral Non-small Cell Lung Cancer Patients: What and How?
Authors
Han-Yu Deng, MD
Jie Zhou, MD
Ru-Lan Wang, MD
Rui Jiang, MD
Da-Xing Zhu, MD
Xiao-Jun Tang, MD
Qinghua Zhou, MD
Publication date
01-02-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07926-3

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