Predictive Factors for Lymph Node Metastasis in Clinical Stage IA Lung Adenocarcinoma

Ye, Bo; Cheng, Ming Fang; Li, Wang; Ge, Xiaoxiao; Geng, Jia; Feng, Jian; Yu, Yang; Hu, De Jin

doi:10.1016/j.athoracsur.2014.03.005

Cited by 91 publications

(92 citation statements)

References 24 publications

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“…There are other parameters and tumour characteristics that increase the risk of mediastinal nodal involvement, especially when combining them. This is the situation of adenocarcinoma histological type, combined with tumour size, FDG uptake value or serum CEA level (7)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

“…Many authors, as mentioned above (7,8), have encountered a high SUVmax value as a predictor of mediastinal metastases in combination with other factors, but also higher uptake values have been associated with worse survival and increased risk of recurrence in patients with stage I NSCLC (10). The main limitation of these studies is that not all of them report a multivariate analysis of the different prognostic factors, the difficulty to standardize the PET uptake values and to define a prognostic SUV cut-off, which leads to confusion when comparing studies (11).…”

Section: Controversies On Lung Cancer: Pros and Consmentioning

confidence: 99%

“…In a meta-analysis by Wang et al (7), PET-CT staging in cI tumours had a negative predictive value of 92%, but a higher risk of occult mediastinal metastases was observed in pT2 tumours, adenocarcinomas, and primary tumours with high uptake. Ye et al (8) retrospectively studied 651 patients with stage cIA adenocarcinoma, observing that those presenting with a pure solid pattern, serum carcinoembryonic antigen (CEA) level exceeding 5 ng/dL and maximum standardized uptake value (SUVmax) exceeding 5 were at a higher risk of presenting lymph node metastases. Similarly, Koike et al (9) retrospectively analyzed 894 patients with peripheral cIA NSCLC encountering these four predictors for mediastinal nodal metastases: age (≤67 years), preoperative serum CEA level (≥3.5 ng/mL), tumour size (≥2 cm) and consolidation/ tumour ratio on high resolution CT (≥89%).…”

Section: Controversies On Lung Cancer: Pros and Consmentioning

confidence: 99%

See 2 more Smart Citations

Pros: should a patient with stage IA non-small cell lung cancer undergo invasive mediastinal staging?

Obiols¹,

Call²

2016

Transl. Lung Cancer Res.

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Section: Discussionmentioning

confidence: 99%

Section: Controversies On Lung Cancer: Pros and Consmentioning

confidence: 99%

Section: Controversies On Lung Cancer: Pros and Consmentioning

confidence: 99%

See 1 more Smart Citation

Pros: should a patient with stage IA non-small cell lung cancer undergo invasive mediastinal staging?

Obiols¹,

Call²

2016

Transl. Lung Cancer Res.

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“…As the GGO status can predict LNM more accurately than the tumor diameter, [11] we believe decisions on whether to perform mediastinal lymphadenectomy should not be based purely on the tumor size.…”

Section: Although 2009 Guidelines Of the Internationalmentioning

confidence: 99%

Analysis of predictors of lymph node metastasis in clinical T1aN0M0 pulmonary adenocarcinoma

Gao¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada T 1 aN 0 M 0 akciğer adenokarsinomlu hastalarda lenf nodu metastazının öngördürücüleri belirlendi. Ça lış ma pla nı: Bu retrospektif çalışmaya Ocak 2011 -Ekim 2015 tarihleri arasında tedavi edilen T 1 aN 0 M 0 klinik evre akciğer adenokarsinomlu toplam 364 hasta (170 erkek, 194 kadın; ort. yaş 60.8±8.4 yıl; dağılım 33-82 yıl) alındı. Tıbbi kayıtlar incelendi ve ilgili klinik veriler ve patoloji sonuçları kaydedildi. Lenf nodu metastazının öngördürücülerini belirlemek için tek değişkenli ve çok değişkenli analizler yapıldı. Bul gu lar: Çok değişkenli analizde buzlu cam opasitesi, yüksek serum karsinoembriyonik antijen konsantrasyonları (>5 ng/mL) ve patojenik tip T 1 a akciğer adenokarsinomunda lenf nodu metastazının öngördürücüleri olarak bulundu. Solid nodüllerde ise; tümör çapı, hava bronkogramı ve yüksek serum karsinoembriyonik antijen konsantrasyonları lenf nodu metastazının öngördürücüleri idi. So nuç: Lenf nodu metastazı, yalnızca buzlu cam opasitesi veya <5 çaplı solid içerikli karma tip tümör ile birliktelik gösteren, klinik evresi T 1 aN 0 M 0 akciğer adenokarsinomlu hastalarda bulunmayabilir. Ancak sistematik lenfadenektomi, yalnızca solid nodülleri olan hastalarda ve ≥5 milimetre çaplı solid içerikli karma tip nodülleri olanlarda, özellikle serum karsinoembriyonik antijen konsantrasyonu 5 ng/mL'den yüksek olanlarda endikedir.Anah tar söz cük ler: Kanser; klinik evre; lenf nodu; küçük hücreli dışı akciğer kanseri; pulmoner adenokarsinoma. ABSTRACTBackground: This study aims to identify the predictors of lymph node metastasis in patients with T 1 aN 0 M 0 adenocarcinoma of the lung. Methods: In this retrospective study, a total of 364 patients (170 males, 194 females; mean age 60.8±8.4 years; range: 33 to 82 years) with clinical stage T 1 aN 0 M 0 pulmonary adenocarcinoma who were treated between January 2011 and October 2015 were included. Medical records were analyzed and relevant clinical data and pathological results were recorded. Univariate and multivariate analyses were performed to identify the predictors of lymph node metastasis. Results: Multivariate analysis demonstrated that groundglass opacity, high serum carcinoembryonic antigen concentrations (>5 ng/mL), and pathogenic type were the predictors of lymph node metastasis in T 1 a pulmonary adenocarcinoma. For solid nodules, tumor diameter, air bronchogram, and high serum carcinoembryonic antigen concentrations were the predictors of lymph node metastasis. Conclusion: Lymph node metastasis cannot be found in patients with clinical stage T 1 aN 0 M 0 pulmonary adenocarcinoma presenting as a pure ground-glass opacity or mixed tumor with solid component of diameter <5 mm. However, systematic lymphadenectomy is indicated in all patients with pure solid nodules and those with mixed nodules with solid component ≥5 mm diameter, particularly those with serum carcinoembryonic antigen concentrations higher than 5 ng/mL.

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“…Then, although the number of cases needed to treat in cIA to obtain a benefit from invasive staging is too high, some subgroups with an increased risk may benefit. As we commented in our previous manuscript, some authors have detected that, in cIA tumours, the combination of tumour characteristics (histological type, consolidation/tumour ratio, tumour size, SUVmax value) and other clinical parameters (serum CEA level, patient's age) have an increased risk of mediastinal involvement (33.8%) (5,6). For this reason, invasive mediastinal staging should have a role in patients with one or a combination of the above-mentioned parameters.…”

mentioning

confidence: 99%

Rebuttal from Dr. Obiols and Dr. Call

Obiols

Call

2016

Transl. Lung Cancer Res.

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show abstract

Predictive Factors for Lymph Node Metastasis in Clinical Stage IA Lung Adenocarcinoma

Cited by 91 publications

References 24 publications

Pros: should a patient with stage IA non-small cell lung cancer undergo invasive mediastinal staging?

Pros: should a patient with stage IA non-small cell lung cancer undergo invasive mediastinal staging?

Analysis of predictors of lymph node metastasis in clinical T1aN0M0 pulmonary adenocarcinoma

Rebuttal from Dr. Obiols and Dr. Call

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