Prognostic significance of lymph node dissection for lung cancer surgery: a narrative review

Ichiki, Yoshinobu; Taguchi, Ryo; Yanagihara, Akitoshi; Umesaki, Tetsuya; Nitanda, Hiroyuki; Sakaguchi, Hirozo; Ishida, Hironori

doi:10.21037/jtd-22-1527

Cited by 2 publications

(1 citation statement)

References 42 publications

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“…Hence, we proposed an adequate but not excessive dissection of LNs, that ensures complete and accurate resection of all metastases without compromising immunotherapy. While systemic LN dissection remains crucial for precise cancer staging, future considerations may involve omitting regional LN resection in appropriately chosen patients without nodal metastasis evidence or with heightened responsiveness to ICBs 47 . With adjuvant immunotherapy’s efficacy been well established in stage IB-IIIA NSCLC 48 – 50 , the impact of DLN count should be considered for planned recipients.…”

Section: Discussionmentioning

confidence: 99%

Impact of lymphadenectomy extent on immunotherapy efficacy in post-resectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study

Deng,

Zhou,

Chen

et al. 2023

International Journal of Surgery

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Background: Lymph node (LN) dissection is a common procedure for non-small cell lung cancer (NSCLC) to ascertain disease severity and treatment options. However, murine studies have indicated that excising tumor-draining LNs diminished immunotherapy effectiveness, though its applicability to clinical patients remains uncertain. Hence, we aim to illustrate the immunological implications of LN dissection by analyzing the impact of dissected LN (DLN) count on immunotherapy efficacy, and to propose a novel “immunotherapy-driven” LN dissection strategy. Materials and Methods: We conducted a retrospective analysis of NSCLC patients underwent anti-PD-1 immunotherapy for recurrence between 2018 and 2020, assessing outcomes based on DLN count stratification. Results: A total of 144 patients were included, of whom 59 had DLN count≤16 [median, IQR: 11, 7-13]; 66 had DLN count>16 [median, IQR: 23, 19-29]. With a median follow-up time of 14.3 months (95%CI: 11.0-17.6), the overall median PFS was 7.9 (95%CI: 4.1-11.7) months, 11.7 (95%CI: 7.9-15.6) months in the combination-therapy subgroup, and 4.8 (95%CI: 3.1-6.4) months in the immunotherapy alone subgroup, respectively. In multivariable Cox analysis, DLN count≤16 is associated with an improved PFS in all cohorts [Primary cohort: HR=0.26 (95%CI: 0.07-0.89), P=0.03; Validation cohort: HR=0.46 (95%CI: 0.22-0.96, P=0.04); Entire cohort: HR=0.53 (95%CI: 0.32-0.89), P=0.02]. The prognostic benefit of DLN count≤16 was more significant in immunotherapy alone, no adjuvant treatment, pN1, female, and squamous carcinoma subgroups. A higher level of CD8+ central memory T cell (Tcm) within LNs was associated with improved PFS (HR: 0.235, 95% CI: 0.065-0.845, P=0.027). Conclusions: An elevated DLN count (cutoff: 16) was associated with poorer immunotherapy efficacy in recurrent NSCLC, especially pronounced in immunotherapy alone subgroup. CD8+Tcm proportions in LNs may also impact immunotherapy efficacy. Therefore, for patients planned for adjuvant immunotherapy, a precise rather than expanded lymphadenectomy strategy to preserve immune-depending LNs is recommended.

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Section: Discussionmentioning

confidence: 99%

Impact of lymphadenectomy extent on immunotherapy efficacy in post-resectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study

Deng,

Zhou,

Chen

et al. 2023

International Journal of Surgery

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Revolutionizing lymph node metastasis imaging: the role of drug delivery systems and future perspectives

Cai,

Li,

Zhong

et al. 2024

J Nanobiotechnol

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The deployment of imaging examinations has evolved into a robust approach for the diagnosis of lymph node metastasis (LNM). The advancement of technology, coupled with the introduction of innovative imaging drugs, has led to the incorporation of an increasingly diverse array of imaging techniques into clinical practice. Nonetheless, conventional methods of administering imaging agents persist in presenting certain drawbacks and side effects. The employment of controlled drug delivery systems (DDSs) as a conduit for transporting imaging agents offers a promising solution to ameliorate these limitations intrinsic to metastatic lymph node (LN) imaging, thereby augmenting diagnostic precision. Within the scope of this review, we elucidate the historical context of LN imaging and encapsulate the frequently employed DDSs in conjunction with a variety of imaging techniques, specifically for metastatic LN imaging. Moreover, we engage in a discourse on the conceptualization and practical application of fusing diagnosis and treatment by employing DDSs. Finally, we venture into prospective applications of DDSs in the realm of LNM imaging and share our perspective on the potential trajectory of DDS development. Graphical Abstract

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Prognostic significance of lymph node dissection for lung cancer surgery: a narrative review

Cited by 2 publications

References 42 publications

Impact of lymphadenectomy extent on immunotherapy efficacy in post-resectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study

Impact of lymphadenectomy extent on immunotherapy efficacy in post-resectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study

Revolutionizing lymph node metastasis imaging: the role of drug delivery systems and future perspectives

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