Abstract
The progression of lung adenocarcinoma through lymph node metastasis has been well established; however, the process of segmental lymph node (LSN) metastasis in cT1N0M0 lung adenocarcinoma remains unclear. We aimed to elucidate the markers of lymph node metastasis to different segments in early-stage lung adenocarcinoma and identify new indications for segmentectomy. A total of 200 patients were enrolled in this study. These patients were diagnosed with cT1N0M0 lung adenocarcinoma after positron emission tomography/computed tomography and received lobectomy and lymph node dissection surgeries. Lymph nodes retrieved from each station were sorted. The metastatic status of the isolated (i) LSNs and several characteristics were analyzed. Patients with ground-glass nodules (GGNs) (P=0.025), AIS/MIA/lepidic adenocarcinoma (P=0.038), nodules with a maximum diameter ≤1 cm (P=0.017), maximum standardized uptake value (SUVmax) < 2.5 (P=0.029), serum carcinoembryonic antigen (CEA) levels ≤4.5 ng/ml (P=0.036), and no N1 lymph nodes metastasis (P=0.036) had significantly lower iLSN metastasis rates than those without these characteristics. Pure GGNs, CEA levels ≤4.5 ng/ml, SUVmax < 2.5, tumors with a maximum diameter of ≤1 cm, or those confirmed to be adenocarcinoma in situ, minimally invasive adenocarcinoma, or invasive lepidic-predominant adenocarcinoma by frozen section may indicate segmentectomy. However, segmentectomy is not suitable for patients with metastasis to the N1 lymph nodes.
Highlights
Lung cancer has the highest morbidity and mortality of any disease worldwide, including China [1, 2]
Lobectomy and mediastinal lymph node dissection have become the standard surgical treatments for non-small-cell lung cancer (NSCLC) [3], but an increasing number of researchers have found that sublobar resection, especially anatomical segmentectomy, has more advantages than and similar results to lobectomy in early-stage cases [4, 5]
We identified size, SUVmax, carcinoembryonic antigen (CEA) level, imaging features, and N1 lymph nodes metastasis as significant independent risk factors for isolated tumor-bearing segmental nodes (iLSNs) metastasis, and AIS/MIA/LPA was identified as a significant independent protective factor against iLSN metastasis (Table 4). erefore, patients without N1 lymph node metastasis (P 0.036), with AIS/MIA/LPA (P 0.038), SUVmax < 2.5 (P 0.029), serum CEA levels ≤4.5 ng/ml (P 0.036), purely ground-glass nodules (GGNs) lesions (P 0.025), or a maximum tumor diameter of ≤1 cm (P 0.017) had significantly lower iLSN metastasis rates than those without these characteristics
Summary
Lung cancer has the highest morbidity and mortality of any disease worldwide, including China [1, 2]. Lobectomy and mediastinal lymph node dissection have become the standard surgical treatments for non-small-cell lung cancer (NSCLC) [3], but an increasing number of researchers have found that sublobar resection, especially anatomical segmentectomy, has more advantages than and similar results to lobectomy in early-stage cases [4, 5]. Lobectomy as the standard of care has become controversial; two prominent studies from Japan (JCOG 0802/0804) and the United States (CALGB 140503) that compare lobectomy to sublobar resection remain inconclusive [6, 7], and these surgical methods for early-stage NSCLC remain a focus of research and discussion. In patients with early-stage, isolated lung adenocarcinomas, the iLSNs may be at low risk for metastasis and, anatomical segmentectomy may be a good option. The evaluation of lymph node metastasis is of great significance for appropriate surgical planning and the recovery of postoperative patients for their long-term benefit
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