Abstract
BackgroundSelection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Here, we sought to identify the clinicopathologic predictors of regional lymph node metastasis in patients intraoperatively diagnosed with stage-I NSCLC.MethodsA retrospective review of 595 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection was performed. Univariate and multivariable logistic regression analysis was performed to determine the independent predictors of regional lymph node metastasis.ResultsUnivariate logistic regression and multivariable analysis revealed three independent predictors of the presence of metastatic hilar lymph nodes, five independent predictors for lobe specific mediastinal lymph nodes, two independent predictors for lobe nonspecific mediastinal lymph nodes and two independent predictors for skipping mediastinal lymph nodes.ConclusionsA complete mediastinal lymph node dissection may be considered for patients suspected of nerve invasion and albumin (> 43.1 g/L) or nerve and vascular invasions. Lobe-specific lymph node dissection should probably be performed for patients suspected of pulmonary membrane invasion, vascular invasion, CEA (> 2.21 ng/mL), and tumor (> 1.6 cm) in the right lower lobe or mixed lobes. Hilar lymph node dissection should probably be performed for patients suspected of having bronchial mucosa and cartilage invasion, vascular invasion, and CEA (> 2.21 ng/mL).
Highlights
Selection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC)
For the lobe nonspecific mediastinal lymph node, univariate analysis indicated that tumor differentiation (OR = 2.68, 95% Confidence intervals (CI) 0.79–9.11; P = 0.115, present 5.1% and absent 2.0%), bronchial mucosa and cartilage invasion (OR = 3.58, 95% CI 1.36–9.45; P = 0.010, present 11.1% and absent 3.4%), vascular invasion (OR = 7.31, 95% CI 2.93–18.21; P < 0.0001, present 18.2% and absent 3.0%), and nerve invasion (OR = 8.81, 95% CI 2.22–34.93; P = 0.002, present 25.0% and absent 3.6%) were the 4 significant risk factors associated with metastasis (Table 5)
For the hilar lymph node, multivariate analysis of the 10 risk factors acquired from univariate analysis showed that only bronchial mucosa and cartilage invasion, vascular invasion, and Carcinoembryonic antigen (CEA) (≤2.21 ng/mL vs. > 2.21 ng/mL, Odds ratio (OR) = 8.49, 95% CI 2.49–28.97; P = 0.001) were the 3 independent predictors associated with metastasis (Table 3)
Summary
Selection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Skipping metastasis is found in a part of these patients, as their CT scan results revealed lymph nodes with short-axis diameters of < 1 cm [4, 5, 7]. Owing to the invasive nature of the procedure and the associated expenses, these diagnostic methods could not be routinely used for screening patients with clinical stage-I disease. These procedures yield a considerable number of false-negative results and complications [8,9,10]
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