Abstract
BackgroundIt is difficult to predict lymph node metastasis in patients with early lung cancer. Pure ground glass opacity (GGO) on computed tomography indicates an early-stage adenocarcinoma that can be removed by limited resection or lobectomy without the need for mediastinal lymph node dissection or sampling, and lung adenocarcinoma with GGO therefore has a good prognosis. We examined the incidence and risk factors of lymph node metastasis in patients with clinical stage IA lung adenocarcinoma.MethodsWe retrospectively analyzed clinical data for 327 patients with stage IA peripheral lung cancer treated in our hospital from March 2014 to December 2018. The patients were divided into four groups according to computed tomography signs. Lobectomy and systematic lymph node dissection were performed in all patients. Correlations between lymph node metastasis and clinical pathological factors were analyzed by logistic regression.ResultsAmong the 327 patients, 26 (7.95%) had lymph node metastasis. No patients with pure GGO or GGO-dominant types had lymph node metastasis. Logistic regression identified tumor diameter, solid content, plasma carcinoembryonic antigen (CEA) level, pathological type, lymphovascular invasion, and pleural invasion as factors related to the presence of lymph node metastasis.ConclusionsTumor diameter, solid component ratio, plasma CEA level, pathological type, vascular tumor thrombus, and pleural invasion are possible independent risk factors for lymph node metastasis in patients with stage IA lung adenocarcinoma. In contrast, lymph node metastasis is rare in patients with pure GGO or GGO-dominant lung adenocarcinoma.
Highlights
It is difficult to predict lymph node metastasis in patients with early lung cancer
Twenty-six patients (7.95%) had mediastinal lymph node metastasis, including (3.1%) with only N1 lymph node metastasis, five (1.5%) with only skip N2 metastatic lymph nodes with no N1 positive nodes, and patients (3.4%) with both N1 and N2 lymph node metastasis
No mediastinal lymph node metastasis was present in the pure GGO (PGGO) and ground glass opacity (GGO) groups, while nine patients (9/120) with solid component dominant type and 17 (17/114) with pure solid tumor type had mediastinal lymph node metastasis
Summary
It is difficult to predict lymph node metastasis in patients with early lung cancer. Pure ground glass opacity (GGO) on computed tomography indicates an early-stage adenocarcinoma that can be removed by limited resection or lobectomy without the need for mediastinal lymph node dissection or sampling, and lung adenocarcinoma with GGO has a good prognosis. We examined the incidence and risk factors of lymph node metastasis in patients with clinical stage IA lung adenocarcinoma. Progress in computed tomography (CT) has led to an increase in the detection rate of early lung nodules, including many early lung cancers [4], with relatively low malignancy and a good postoperative prognosis. We retrospectively examined the incidence and risk factors of lymph node metastasis in patients with clinical stage IA peripheral lung adenocarcinoma with GGO findings, with the aim of providing evidence for future clinical applications
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