Abstract
PurposeThis study aims to explore whether lobe specific lymph node dissection (LND) is adequate for cN0–1 non-small cell lung cancer (NSCLC) or not.MethodsAmong 5613 cN0–1 NSCLC patients, 394 cases (7.0%) with pN2 were enrolled and the distribution of mediastinal lymph node metastasis was analyzed. The included patients were divided into the non-lobe specific lymph node metastasis (NLSLNM) group and the lobe specific lymph node metastasis (LSLNM) group. The clinicopathological characteristics were compared between two groups and multivariable analysis was performed to find independent factors predicting NLSLNM.ResultsThe incidence of pN2 cases deserved serious attention. The proportion of upper zone lymph node metastases was not rare in right (55.0%) and left (35.7%) lower lobe tumors. The proportion of subcarinal zone lymph node involvement was also high in right (21.8%) and left (25.8%) upper lobe tumors. Multivariable analysis showed that elevated carcinoembryonic antigen (CEA) level (P = 0.034), right lower lobe (RLL) tumors (P = 0.022) and station 11 involvement (P = 0.030) were independent risk factors for NLSLNM.ConclusionSystematic LND seems to be superior to lobe specific LND in the assessment of lymph node status and high CEA level, RLL tumors and station 11 involvement are predictors for NLSLNM.
Highlights
Non-small cell lung cancer (NSCLC) has been one of the most common malignant tumors and the leading cause of cancer-related deaths in the world [1, 2]
Surgery is recommended for the patients with resectable non-small cell lung cancer (NSCLC), and lobectomy combined with systematic lymph node dissection (LND) is the standard surgical procedure [5]
The patients included in the analysis fitted with the following criteria: (1) the disease was diagnosed as cN0– 1 preoperatively but was confirmed as pN2 postoperatively; (2) the patient did not have distant metastasis before treatment; (3) the histology was classified as NSCLC; (4) mediastinal LND was performed together with pulmonary resection
Summary
Non-small cell lung cancer (NSCLC) has been one of the most common malignant tumors and the leading cause of cancer-related deaths in the world [1, 2]. Surgery is recommended for the patients with resectable NSCLC, and lobectomy combined with systematic lymph node dissection (LND) is the standard surgical procedure [5]. This surgical treatment has been questioned with the increasing preference of minimal invasive surgery. Selective LND has raised thoracic surgeons’ interest due to the concept of lobe specific lymphatic metastasis. There are still some studies indicating that complete LND is overwhelmingly superior to lobe specific LND from the oncological point of view [13,14,15].
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