Factors Associated with Nodal Upstaging in Clinical T1a-bN0M0 Non-Small Cell Lung Cancers.

Tung-Ming Tsai,Jin-Shing Chen,Chao-Yu Liu,Mong-Wei Lin,Hsao-Hsun Hsu

doi:10.3390/cancers14051277

Abstract

Simple SummaryThe incidence rate of lymph nodal upstaging after curative surgical resection is approximately 10% in clinical stage I non-small cell lung cancer (NSCLC), which can significantly affect the prognosis. The aim of our retrospective study was to reassess the predictive factors of nodal upstaging in patients with clinical T1a-bN0M0 adenocarcinoma. In a cohort of 352 patients with clinical T1a-bN0M0 adenocarcinoma who received standard lobectomy and lymph nodal dissection, 28 (7.95%) patients had lymph nodal upstaging. The significant risk factors include abnormal serum carcinoembryonic antigen levels, solid part tumor diameter ≥ 1.3 cm, and consolidation–tumor ratio ≥ 0.50 on chest computed tomography. Standard lobectomy is recommended for patients with these predictive factors. If neither of the predictive factors are positive, a less invasive procedure may be a reasonable alternative. Further studies are needed to verify these data.Nodal upstaging of lung adenocarcinoma occurs when unexpected pathological lymph node metastasis is found after surgical intervention, and may be associated with a worse prognosis. In this study, we aimed to determine the predictive factors of nodal upstaging in cT1a-bN0M0 primary lung adenocarcinoma. We retrospectively reviewed a prospective database (January 2011 to May 2017) at National Taiwan University Hospital and identified patients with cT1a-bN0M0 (solid part tumor diameter ≤ 2 cm) lung adenocarcinoma who underwent video-assisted thoracoscopic lobectomy. Logistic regression models and survival analysis were used to examine and compare the predictive factors of nodal upstaging. A total of 352 patients were included. Among them, 28 (7.8%) patients had nodal upstaging. Abnormal preoperative serum carcinoembryonic antigen (CEA) levels, solid part tumor diameter ≥ 1.3 cm, and consolidation–tumor (C/T) ratio ≥ 0.50 on chest computed tomography (CT) were significant predictive factors associated with nodal upstaging, and patients with nodal upstaging tended to have worse survival. Standard lobectomy is recommended for patients with these predictive factors. If neither of the predictive factors are positive, a less invasive procedure may be a reasonable alternative. Further studies are needed to verify these data.

Highlights

Non-small cell lung cancer (NSCLC) with small tumor size is frequently detected due to the prevalence of computed tomography (CT) as a screening tool for pulmonary lesions
Preoperative invasive surgery is the gold standard for detecting lymph nodal metastasis, it is controversial in cases with small pulmonary nodules or the absence of suspicious lymph nodes on preoperative imaging [3]
We retrospectively reviewed 352 patients with clinical T1a-bN0M0 lung adenocarcinoma who underwent thoracoscopic lobectomy and radical hilar and mediastinal lymph node dissection

Summary

Introduction

Non-small cell lung cancer (NSCLC) with small tumor size is frequently detected due to the prevalence of computed tomography (CT) as a screening tool for pulmonary lesions. Lobectomy with systemic lymph node dissection (LND) is considered the standard treatment for early stage NSCLC [1,2], there is still controversy on how to harvest the lymph nodes and determine the extent of LND, leading to the debate on surgical management choices. Especially in determining the lymph nodal status, is essential before deciding on the surgical procedure for curative surgery. Preoperative invasive surgery (mediastinoscopy or endobronchial ultrasound biopsy) is the gold standard for detecting lymph nodal metastasis, it is controversial in cases with small pulmonary nodules or the absence of suspicious lymph nodes on preoperative imaging [3]. Known as occult metastasis, can significantly affect the prognosis, especially when there is mediastinal or contralateral involvement. The incidence rate of lymph nodal upstaging is approximately 10% in patients with clinical stage I NSCLC [4,5]. Several clinical risk factors are associated with this unfavorable situation

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