Run-Bin Liang1,2,3, Jie Yang1,2,3, Tai-Shan Zeng4, Hao Long1,2,3, Jian-Hua Fu1,2,3, Lan-Jun Zhang1,2,3, Peng Lin1,2,3, Xin Wang1,2,3, Tie-Hua Rong1,2,3, Xue Hou5,6,7, Hao-Xian Yang8,9,10. 1. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China. 2. State Key Laboratory of Oncology in South China, Guangzhou City, Guangdong Province, China. 3. Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China. 4. School of Mathematical Sciences, South China Normal University, Guangzhou City, Guangdong Province, China. 5. State Key Laboratory of Oncology in South China, Guangzhou City, Guangdong Province, China. houxue@sysucc.org.cn. 6. Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China. houxue@sysucc.org.cn. 7. Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China. houxue@sysucc.org.cn. 8. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, China. yanghx@sysucc.org.cn. 9. State Key Laboratory of Oncology in South China, Guangzhou City, Guangdong Province, China. yanghx@sysucc.org.cn. 10. Collaborative Innovation Center for Cancer Medicine, Guangzhou City, Guangdong Province, China. yanghx@sysucc.org.cn.
Abstract
OBJECTIVE: We aimed to investigate the incidence and distribution of mediastinal lymph node metastases (MLNM) in operable non-small cell lung cancer (NSCLC) with the purpose of guiding mediastinal lymph node dissection (MLND). METHODS: A total of 4511 NSCLC patients who underwent resection between January 2001 and December 2014 were included. These patients were preoperatively untreated and grouped according to the primary tumor lobes. The incidence and distribution of pathologic MLNM were compared among groups, and multivariate analysis was conducted to find the independent factors impacting MLNM. RESULTS: Lymph node involvement was observed in 1784 patients (39.5%). A total of 628 cases (13.9%) were N1-positive only, 752 cases (16.7%) were both N1- and N2-positive, and 404 cases (9.0%) were N2-positive only. The most common sites of mediastinal metastasis for different primary tumor lobes were the right upper lobe, station 4R (21.5%, 192/893); right middle lobe, station 7 (21.1%, 69/327); right lower lobe, station 7 (24.1%, 212/878); left upper lobe, station 5 (22.2%, 224/1008); and left lower lobe, station 7 (21.7%, 136/628). However, when only N2 cases were considered, each mediastinal lymph node zone can be involved with metastasis to a high proportion (> 5%). Multivariable analyses showed that poor cell differentiation, adenocarcinoma, larger tumor size, central type, and younger age were independent factors favoring MLNM. CONCLUSIONS: Different primary tumor locations have a different propensity to be sites of MLNM; however, once MLNM occurs, each zone can be involved and should not be neglected. Systematic MLND is the preferred procedure for operable NSCLC.
OBJECTIVE: We aimed to investigate the incidence and distribution of mediastinal lymph node metastases (MLNM) in operable non-small cell lung cancer (NSCLC) with the purpose of guiding mediastinal lymph node dissection (MLND). METHODS: A total of 4511 NSCLCpatients who underwent resection between January 2001 and December 2014 were included. These patients were preoperatively untreated and grouped according to the primary tumor lobes. The incidence and distribution of pathologic MLNM were compared among groups, and multivariate analysis was conducted to find the independent factors impacting MLNM. RESULTS: Lymph node involvement was observed in 1784 patients (39.5%). A total of 628 cases (13.9%) were N1-positive only, 752 cases (16.7%) were both N1- and N2-positive, and 404 cases (9.0%) were N2-positive only. The most common sites of mediastinal metastasis for different primary tumor lobes were the right upper lobe, station 4R (21.5%, 192/893); right middle lobe, station 7 (21.1%, 69/327); right lower lobe, station 7 (24.1%, 212/878); left upper lobe, station 5 (22.2%, 224/1008); and left lower lobe, station 7 (21.7%, 136/628). However, when only N2 cases were considered, each mediastinal lymph node zone can be involved with metastasis to a high proportion (> 5%). Multivariable analyses showed that poor cell differentiation, adenocarcinoma, larger tumor size, central type, and younger age were independent factors favoring MLNM. CONCLUSIONS: Different primary tumor locations have a different propensity to be sites of MLNM; however, once MLNM occurs, each zone can be involved and should not be neglected. Systematic MLND is the preferred procedure for operable NSCLC.
Authors: José Ramón Jarabo Sarceda; Sergio Bolufer Nadal; Roberto Mongil Poce; Pedro López de Castro; Ramón Moreno Balsalobre; Juan Carlos Peñalver Cuesta; Raul Embún Flor; Joaquín Pac Ferrer; Francisco Javier Algar Algar; Antonio Pablo Gámez García; Marcelo F Jiménez; Jesús Gabriel Sales-Badía; Eva Pereira; Bartomeu Massuti; Mariano Provencio; Florentino Hernando Trancho Journal: Transl Lung Cancer Res Date: 2021-04
Authors: Marcin M Cackowski; Marcin Zbytniewski; Grzegorz M Gryszko; Michał Dziedzic; Katarzyna Woźnica; Tadeusz M Orłowski; Dariusz A Dziedzic Journal: J Thorac Dis Date: 2022-09 Impact factor: 3.005