Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients

Billè, Andrea; Woo, Kaitlin M.; Ahmad, Usman; Rizk, Nabil P.; Jones, David R.

doi:10.1093/ejcts/ezw400

Cited by 85 publications

(70 citation statements)

References 32 publications

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“…It has been widely recognized that adequate lymph node assessment plays a vital role in the accurate staging and prognostic evaluation of NSCLC patients, for which SLND has been universally recommended and accepted . However, because of an increase in the detection of early‐stage lung cancer, some scholars have advocated that this classic approach might not be necessary for all early‐stage lung cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of non‐lobe‐specific lymph node metastasis in clinical stage IA non‐small cell lung cancer

et al. 2019

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Background The rationality of selective mediastinal lymph node dissection based on lobe‐specific metastasis is still controversial. The correlation of lymph node metastasis in lobe‐specific lymphatic drainage regions (LSDRs) and non‐LSDRs has not been widely reported. The purpose of this study was to investigate the variables affecting nodal metastasis in non‐LSDRs and to further evaluate the rationality of selective lymphadenectomy in clinical stage IA non‐small cell lung cancer (NSCLC) patients. Methods The clinicopathological information of 316 patients with clinical stage IA NSCLC who underwent lobectomy with systematic lymph node dissection between June 2014 and June 2018 was retrospectively collected for analysis. Results The overall lymph node metastasis rate was 19.3%. For 35 patients with positive LSDR lymph nodes, the non‐LSDR lymph node metastasis rate was 31.4%. Only one patient (0.4%) among 281 patients with negative LSDR lymph nodes had nodal spread in non‐LSDRs. Univariate analysis identified that solid consistency, worse differentiation, and positive status in LSDRs were unfavorable predictive variables of lymph node metastasis in non‐LSDRs. Multivariate analysis showed that nodal metastasis in LSDRs was the only independent predictor of nodal involvement in non‐LSDRs (P < 0.001). Conclusion For patients with clinical stage IA NSCLC, non‐LSDR lymph node metastasis mainly depends on the involvement of the LSDR lymph node. Our observations may indicate the potential implications for the reasonable management of lymphadenectomy in stage IA NSCLC patients.

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Section: Discussionmentioning

confidence: 99%

Assessment of non‐lobe‐specific lymph node metastasis in clinical stage IA non‐small cell lung cancer

et al. 2019

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“…Interestingly, in this subgroup, all metastatic lymph nodes were in so-called lobe-specific stations [3]. The median number of involved nodes was 2.…”

Section: Resultsmentioning

confidence: 83%

N2 lung cancer is not all the same: an analysis of different prognostic groups†

Bertoglio

Ricciardi

Alì

et al. 2018

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES:The International Association for the Study of Lung Cancer (IASLC) recently proposed a change in the staging system for N2, based on the metastatic station number: N2a1 (a single metastatic station with no hilar involvement), N2a2 (a single metastatic station with hilar involvement) and N2b (multiple metastatic stations). The aim of our study was to validate the IASLC proposal in a cohort of patients with pathological N2 disease. METHODS:All patients with pathological T1-T2 N2 non-small-cell lung cancer who were operated on between 2006 and 2010 in our department were enrolled. The patients had lobectomy, bilobectomy or pneumonectomy without induction therapy; patients with any type of extended resection were excluded. All patients had adjuvant treatment. The impact of the new IASLC proposal on the overall and disease-free survival rates was then analysed. RESULTS:Ninety-three patients were selected. The median follow-up period and overall survival time were 92 and 28.8 months, respectively. According to the new IASLC proposal, we observed 22 cases of N2a1, 54 N2a2 and 17 N2b. Patients with N2a1 had a significantly better overall survival than those with N2a2 and N2b (P = 0.041); the difference between N2a2 and N2b was not significant (P = 0.19). Patients with N2a1 squamous cell carcinoma had a significantly better overall survival than those with other histological diagnoses (P = 0.046). The disease-free interval was longer in patients with N2a1 than those in other groups (P = 0.021).CONCLUSIONS: Our experience partially validates the IASLC proposal; the introduction of quantitative criteria for N staging might improve stratification of patients and the assignment to the correct therapeutic path.

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“…Occult N2 disease was detected in 9% of these patients (146/1,667), and risk factors for occult N2 disease were histology (adenocarcinoma) and vascular invasion. Skip metastases (defined as N2 lymph node involvement without N1 involvement) was observed in 34% of patients with pN2 disease (47/139), and 16% of patients with occult N2 disease had mediastinal lymph node metastases beyond the extent of L-SND (6 with RUL tumors and 2 with LUL tumors had metastasis to station 7; 6 with RLL tumors had metastasis to station 2R or 4R; and 8 with LLL tumors had metastasis to station 5 or 6); consequently, it was concluded that SND should be performed even in surgery for clinical stage I NSCLC (18). The rate of occult N2 was similar and the rate of skip metastasis was higher compared to previous reports (19).…”

Section: Editorialmentioning

confidence: 99%

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

2017

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The standard surgical treatment for early stage non-smallcell lung cancer (NSCLC) is lobectomy or pneumonectomy with systematic lymph node dissection (SND) (1,2). In 2006, the European Society of Thoracic Surgeons (ESTS) released guidelines for intraoperative lymph node staging in NSCLC, in which intraoperative procedures for lymph nodes were classified into five groups; selected lymph node biopsy, (systematic) sampling, lobe-specific lymph node dissection (L-SND), SND, and extended lymph node dissection; and it was recommended to provide SND in all cases of complete resection of NSCLC (3). SND was first reported by Cahan in 1960 (4). This technique is designed to provide precise information on nodal status, which is necessary for optimal postoperative treatment, and to achieve better local cancer control that subsequently improves postoperative survival. However, the influence of SND on local control and survival remains uncertain, even though its value for accurate histologic staging of nodal status is well accepted. In addition, some reports have shown that SND tends to require longer operative times and to increase perioperative complications, compared to other procedures (5-7). Thus, many surgeons tend to avoid SND and perform "less invasive" intraoperative treatment for lymph nodes (8).Based on this background, L-SND has attracted attention as a procedure in which some nodal stations are left untouched and unresected depending on the lobar location of the primary tumor. L-SND is designed based on characteristic mediastinal nodal metastasis patterns that occur for different primary tumor locations. In 1998, Okada et al. showed the characteristic skip N2 metastasis pattern (9), and in 1999, Asamura et al. reported characteristic patterns based on the primary tumor location (10). According to their report, tumors in the RUL and LUL tend to metastasize to the superior mediastinal lymph node station, whereas single-station metastasis to the subcarinal node is very rare; while tumors in the RLL or LLL show metastases to the subcarinal node and to the superior mediastinal or aortic node (10). However, Asamura et al. concluded that subcarinal node metastasis was the touchstone of mediastinal spread of RLL and LLL tumors because singlenode or single-station metastases were more common in the subcarinal station and the prognosis of RLL or LLL tumors with both subcarinal and superior mediastinal lymph node metastases was extremely poor, even if SND was performed. Further, a specific lymphatic spread pattern was not identified for RML tumors (10).Comparing L-SND with SND from nodal staging Editorial

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Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients

Abstract: Sixteen percent of pN2 patients had mediastinal lymph node metastasis beyond the lobe-specific lymphatic drainage. We recommend a complete lymphadenectomy be performed, even in clinical stage I NSCLC.

Cited by 85 publications

References 32 publications

Assessment of non‐lobe‐specific lymph node metastasis in clinical stage IA non‐small cell lung cancer

Assessment of non‐lobe‐specific lymph node metastasis in clinical stage IA non‐small cell lung cancer

N2 lung cancer is not all the same: an analysis of different prognostic groups†

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

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