The Prognostic Significance of Metastasis to Lymph Nodes in Aortopulmonary Zone (Stations 5 and 6) in Completely Resected Left Upper Lobe Tumors

Çıtak, Necati; Sayar, Adnan; Metin, Muzaffer; Büyükkale, Songül; Kök, Abdülaziz; Solak, Okan; Yurt, Sibel; Gürses, Atilla

doi:10.1055/s-0035-1546463

Cited by 11 publications

(3 citation statements)

References 22 publications

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“…Two other studies used patient information from the same database, so we excluded a study with fewer patients. Finally, a total of 10 studies 6 , 13 – 21 were identified in the meta-analysis. The PRISMA statement of the selection flow diagram is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Prognostic value of different N1 lymph node zones in pN1M0 non-small cell lung cancer: a systematic review and meta-analysis

Lin

Chu

et al. 2021

Sci Rep

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The IASLC lymph node map grouped the lymph node stations into “zones” for prognostic analyses. In the N1 lymph nodes group, N1 nodes are divided into the Hilar/Interlobar zone (N1h) and Peripheral zone (N1p). There is no consensus on the different prognostic values of N1 lymph nodes in N1h and N1p. Therefore, we conducted a systematic review and meta-analysis to assess the survival difference between N1h and N1p in patients of pN1M0 NSCLC. Medline, the Cochrane Library, Embase, and the Web of science were systematically searched to identify relevant studies published up to April 4th, 2020. A retrospective and prospective cohort study comparing N1h versus N1p to the pN1M0 NSCLC was included. Hazard ratios (HRs) for OS were aggregated according to a fixed or random-effect model. Ten publications for 1946 patients of pN1M0 NSCLC were included for the meta-analysis.The 5-year OS was lower for patients with N1h (HR: 1.67, 95% CI 1.44–1.94; P < 0.001). The pooled 5-year OS in N1h and N1p were 40% and 56%, respectively. The patients in pN1M0 NSCLC have different survival according to different N1 lymph node zones involvement: patients with N1p metastasis have a better prognosis than those with N1h metastasis.

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Section: Resultsmentioning

confidence: 99%

Prognostic value of different N1 lymph node zones in pN1M0 non-small cell lung cancer: a systematic review and meta-analysis

Lin

Chu

et al. 2021

Sci Rep

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“…Based on studies focused on skip metastasis, direct lymphatic drainage pathways appear to explain why the upper lobe is the predominant site of primary lung cancer linked to skip metastasis [ 88 ]. Based on this notion, some studies have explored the question whether lymph node stations 5 and 6 should not be considered N1 nodes for left upper lobe tumors, which would make pre-operative tissue confirmation for these cases less stringent [ 89 , 90 , 91 ]. A meta-analysis by Wang et al [ 92 ] focusing on skip vs non-skip N2 in patients with pN2, reported higher 5-year survival rates in the skip-N2 group with an estimated odd ratio of 0.078 (95% CI 0.71–0.86, p < 0.001, I 2 67.1%).…”

Section: Discussionmentioning

confidence: 99%

True Prevalence of Unforeseen N2 Disease in NSCLC: A Systematic Review + Meta-Analysis

Hui

Charaf²,

Hendriks

et al. 2023

Cancers

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Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67–9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31–58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored.

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“…The oncologic outcome of pN1 patients can be evaluated by several methods (16,17). Data from the IASLC Lung Cancer Staging Project have suggested that it might be appropriate to subdivide the current N staging descriptors into N1a (single N1 zone) and N1b (multiple N1 zones) (1).…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy may improve outcome of patients with non-small-cell lung cancer with metastasis of intrapulmonary lymph nodes after systematic dissection of N1 nodes

Wang¹,

Yan²,

Wang³

et al. 2018

Chinese Journal of Cancer Research

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ObjectiveSurvival benefit of adjuvant chemotherapy (AC) of patients with intrapulmonary lymph node (IPLN) metastasis (level 12−14) needs investigation. We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.MethodsFirst, 155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated. Patients received systematic dissection of N2 and N1 nodes. For patients with IPLN metastasis, survival outcomes were compared between those receiving AC and those not receiving AC.ResultsIn this group, 112 cases (72.3%) had IPLN metastasis and 55 cases (35.5%) had N1 involvement limited to level 13−14 without further disease spread to higher levels. Patients with IPLN involvement had a better prognosis than that of patients with hilar-interlobar involvement. For the intrapulmonary N1 group (level 12−14-positive, level 10−11-negative or unknown, n=112), no survival benefit was found between the AC group and non-AC group [5-year overall survival (OS): 54.6±1.6vs. 50.4±2.4 months, P=0.177]. However, 76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports (level 12−14-positive, level 10−11 both negative), oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup (5-year OS: 57.3±1.5vs. 47.1±3.2 months, P=0.002). ConclusionsOncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.

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The Prognostic Significance of Metastasis to Lymph Nodes in Aortopulmonary Zone (Stations 5 and 6) in Completely Resected Left Upper Lobe Tumors

Abstract: LUL tumors with metastasis in the AP zone lymph nodes, especially skip metastasis, were associated with a more favorable prognosis than other mediastinal lymph nodes. However, the therapy of choice for lung cancer with N2(5,6+) has not been clarified yet.

Cited by 11 publications

References 22 publications

Prognostic value of different N1 lymph node zones in pN1M0 non-small cell lung cancer: a systematic review and meta-analysis

Prognostic value of different N1 lymph node zones in pN1M0 non-small cell lung cancer: a systematic review and meta-analysis

True Prevalence of Unforeseen N2 Disease in NSCLC: A Systematic Review + Meta-Analysis

Adjuvant chemotherapy may improve outcome of patients with non-small-cell lung cancer with metastasis of intrapulmonary lymph nodes after systematic dissection of N1 nodes

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