Define relative incomplete resection by highest mediastinal lymph node metastasis for non-small cell lung cancers: Rationale based on prognosis analysis

Re-appraisal of N2 disease by lymphatic drainage pattern for non-small-cell lung cancers: By terms of nodal stations, zones, chains, and a composite

“…Other authors have also observed that involvement of both the highest and the most distant (#8 and #9 nodes) mediastinal lymph nodes is highly predictive of poor survival [18]. Moreover, similar results have been obtained for cases of lymphadenectomy [19]. Histological down-staging of N2-IIIa disease following neo-adjuvant chemotherapy has provided evidence that this therapeutic strategy might also be an operative indication [20].…”

Propensity-Matched Analysis of Clinical Relevance of the Highest Mediastinal Lymph Node Metastasis

“…For example, a recent retrospective study did not demonstrate significant long-term survival differences between patients with HMLL-positive and those with HMLL-negative NSCLC. 5 This finding is contrary to that of Zheng and colleagues, 6 who found that involvement of the HMLL resulted in poorer prognosis and predicated an advanced stage of the disease. No studies have considered selection biases and competing risk events, however.…”

“…The definition of HMLL was based on the recommendations of several studies. 5,6 In the current study, 2R lymph nodes were considered the HMLL on the right side, whereas 4L, 5, or 6 lymph nodes were considered the HMLL on the left side.…”

“…Uncertain resection, as a crossing area between complete resection and incomplete resection, 6 is not rare in clinical practice. A recent study reported that 56% of 14,712 NSCLC patients underwent uncertain resection in the IASLC Lung Cancer Staging Project database.…”

The Prognosis According to Patterns of Mediastinal Lymph Node Metastasis in Pathologic Stage IIIA/N2 Non-Small Cell Lung Cancer

“…They have often been defined as the lymph nodes above the horizontal plane of the left brachiocephalic vein [7]; moreover, lymph node level 4 on the left side and lymph node level 1/2 on the right side may be defined for them [15]. However, they are most commonly defined as one of the resected MLNs located closest to the head.…”