Lobe-specific Lymph Node Dissection in Clinical Stage IA Solid-dominant Non–small-cell Lung Cancer: A Propensity Score Matching Study

Zhao, Yue; Mao, Yousheng; He, Jié; Gao, Shugeng; Zhang, Zhirong; Ding, Ningning; Xue, Qi; Gao, Yushun; Wang, Dali; Zhao, Jun; Tan, Fengwei; Yuan, Ligong; Li, Feng; Wang, Shuaibo; Yang, Lin

doi:10.1016/j.cllc.2020.09.012

Cited by 24 publications

(15 citation statements)

References 31 publications

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“…As shown in our previous retrospective study, the subcarinal and lower mediastinal lymph nodes were all negative when the tumour was located in the upper lobe and with a size of ≤2 cm, and the upper mediastinal lymph nodes were all negative when the tumour was located in the lower lobe and with a size of ≤2 cm 9. It reminded us that the lobe-specific lymph node metastasis pattern might be noticed, and the L-SLND might be practical, with comparable long-term survival and fewer postoperative complications 13. Therefore, we conducted a double-blind, randomised and parallel-controlled clinical trial to determine the preferred treatment between L-SLND and SLND for early-stage NSCLC.…”

Section: Introductionmentioning

confidence: 78%

“… 9 It reminded us that the lobe-specific lymph node metastasis pattern might be noticed, and the L-SLND might be practical, with comparable long-term survival and fewer postoperative complications. 13 Therefore, we conducted a double-blind, randomised and parallel-controlled clinical trial to determine the preferred treatment between L-SLND and SLND for early-stage NSCLC. We hypothesised that L-SLND was not inferior to SLND in safety and long-term oncological results.…”

Section: Introductionmentioning

confidence: 99%

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LobE-Specific lymph node diSsectiON for clinical early-stage non-small cell lung cancer: protocol for a randomised controlled trial (the LESSON trial)

et al. 2022

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IntroductionLung cancer was the most common malignancy and the leading cause of cancer-related death in China or worldwide, and surgery is still the preferred treatment for early-stage non-small cell lung cancer (NSCLC). The pattern of lymph node metastasis was found potentially lobe specific, and thus, lobe-specific lymph node dissection (L-SLND) was proposed to be an alternative to systematic lymph node dissection (SLND) for the treatment of early-stage NSCLC.Methods and analysisThe LobE-Specific lymph node diSsectiON trial is a single-institutional, randomised, double-blind and parallel controlled trial to investigate the feasibility of L-SLND in clinically diagnosed stage IA1-2 NSCLC with ground-glass opacity components (≥50%). The intraoperative frozen section examination of surgical tissues confirms the histological type of NSCLC. We hypothesise that L-SLND (experimental group) is not inferior to SLND (control group) and intend to include 672 participants for the experimental group and 672 participants for the control group with a follow-up duration of 60 months. The primary outcomes are 5-year disease-free survival and 5-year overall survival. The secondary outcomes are metastatic lymph node ratio, postoperative complication incidence and mortality, duration of operation, duration of anaesthesia (min), the volume of bleeding (mL) and drainage volume. The intention-to-treat analysis would be performed in the trial.Ethics and disseminationThis trial was approved by the ethics committee on biomedical research, West China Hospital of Sichuan University (2021-332). Informed consent would be obtained from all participants, and dissemination activities would include academic conference presentations and peer-reviewed publications.Trial registration numberThis trial was registered in the Chinese Clinical Trial Registry, ChiCTR2100048415.

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Section: Introductionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

LobE-Specific lymph node diSsectiON for clinical early-stage non-small cell lung cancer: protocol for a randomised controlled trial (the LESSON trial)

et al. 2022

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“…However, several authors have reported that L-SND and SND have similar effects in the dissection of stage IA NSCLC for the following reasons: (a) equivalent survival outcomes were detected between L-SND and SND, (b) rare frequency of deviant lymph node metastases from lobe-specific lymphatic pathways, and (c) dismal prognosis in cases of deviant metastases [4,22]. Recently, Zhao et al reported that L-SND had similar efficacy to SND in terms of survival, recurrence, lymph node dissection, and perioperative recovery in patients with clinical IA soliddominant NSCLC, as well as significant advantages in reducing operative complications (after propensity matching) [3]. Although further investigation is needed, our results add to the literature because they indicate that L-SND might be more suitable than SND, even in patients with CEA abnormality.…”

Section: Discussionmentioning

confidence: 99%

“…However, lobe-specific nodal dissection (L-SND) was recently considered as an alternative to SND for the dissection of early-staged NSCLCs. Several authors have reported lobe-specific lymph node (LN) spread patterns [3]. However, SND is considered an important option, based on the following: (a) subcarinal or upper mediastinal metastases are rarely identified in upper or lower lobe NSCLC [4] and (b).…”

Section: Introductionmentioning

confidence: 99%

“…However, SND is considered an important option, based on the following: (a) subcarinal or upper mediastinal metastases are rarely identified in upper or lower lobe NSCLC [4] and (b). SND and L-SND have similar effects on oncological prognosis but L-SND offers a significant advantage in reducing postoperative complications, especially in patients with cN0 or stage I NSCLC [3]. However, there are still some clinical studies with adverse results, and few reports have focused on L-SND [5].…”

Section: Introductionmentioning

confidence: 99%

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Permissible Outcomes of Lobe-Specific Lymph Node Dissection for Elevated Carcinoembryonic Antigen in Non-Small Cell Lung Cancer

et al. 2021

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Background and Objectives: Lobe-specific nodal dissection (L-SND) is currently acceptable for the dissection of early-stage non-small cell lung cancer (NSCLC) but not for cancers of more advanced clinical stages. We aimed to assess the efficacy of L-SND, compared to systemic nodal dissection (SND). Materials and Methods: We retrospectively collected the clinical data of patients with carcinoembryonic antigen (CEA) abnormality who underwent complete resection of NSCLC via lobectomy or more in addition to either SND or L-SND at two cancer-specific institutions from January 2006 to December 2017. Results: A total of 799 patients, including 265 patients who underwent SND and 534 patients who underwent L-SND, were included. On multivariate analysis, thoracotomy, more than lobectomy, cN1-2, advanced pathological stage, adjuvant treatment, and EGFR or ALK were strongly associated with SND. No significant differences were found in overall survival, disease-free survival, and overtime survival after propensity adjustment (p = 0.09, p = 0.11, and p = 0.50, respectively). There were no significant differences in local (p = 0.16), regional (p = 0.72), or distant (p = 0.39) tumor recurrence between the two groups. Conclusions: SND did not improve the prognosis of NSCLC patients with CEA abnormality. Complete pulmonary resection via L-SND seems useful for NSCLC patients with CEA abnormality.

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Nomograms for intraoperative prediction of lymph node metastasis in clinical stage IA lung adenocarcinoma

Zhai

et al. 2023

Cancer Medicine

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Background Accurate prediction of lymph node metastasis (LNM) is critical for selecting optimal surgical procedures in early‐stage lung adenocarcinoma (LUAD). This study aimed to develop nomograms for intraoperative prediction of LNM in clinical stage IA LUAD. Methods A total of 1227 patients with clinical stage IA LUADs on computed tomography (CT) were enrolled to construct and validate nomograms for predicting LNM (LNM nomogram) and mediastinal LNM (LNM‐N2 nomogram). Recurrence‐free survival (RFS) and overall survival (OS) were compared between limited mediastinal lymphadenectomy (LML) and systematic mediastinal lymphadenectomy (SML) in the high‐ and low‐risk groups for LNM‐N2, respectively. Results Three variables were incorporated into the LNM nomogram and the LNM‐N2 nomogram, including preoperative serum carcinoembryonic antigen (CEA) level, CT appearance, and tumor size. The LNM nomogram showed good discriminatory performance, with C‐indexes of 0.879 (95% CI, 0.847–0.911) and 0.880 (95% CI, 0.834–0.926) in the development and validation cohorts, respectively. The C‐indexes of the LNM‐N2 nomogram were 0.812 (95% CI, 0.766–0.858) and 0.822 (95% CI, 0.762–0.882) in the development and validation cohorts, respectively. LML and SML had similar survival outcomes among patients with low risk of LNM‐N2 (5‐year RFS, 88.1% vs. 89.5%, Pp = 0.790; 5‐year OS, 96.0% vs. 93.0%, p = 0.370). However, for patients with high risk of LNM‐N2, LML was associated with worse survival (5‐year RFS, 64.0% vs. 77.4%, p = 0.036; 5‐year OS, 66.0% vs. 85.9%, p = 0.038). Conclusions We developed and validated nomograms to predict LNM and LNM‐N2 intraoperatively in patients with clinical stage IA LUAD on CT. These nomograms may help surgeons to select optimal surgical procedures.

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Lobe-specific Lymph Node Dissection in Clinical Stage IA Solid-dominant Non–small-cell Lung Cancer: A Propensity Score Matching Study

Cited by 24 publications

References 31 publications

LobE-Specific lymph node diSsectiON for clinical early-stage non-small cell lung cancer: protocol for a randomised controlled trial (the LESSON trial)

LobE-Specific lymph node diSsectiON for clinical early-stage non-small cell lung cancer: protocol for a randomised controlled trial (the LESSON trial)

Permissible Outcomes of Lobe-Specific Lymph Node Dissection for Elevated Carcinoembryonic Antigen in Non-Small Cell Lung Cancer

Nomograms for intraoperative prediction of lymph node metastasis in clinical stage IA lung adenocarcinoma

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