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The comparison of Lobe-Specific or Systematic Mediastinal Lymph Node Dissection for Early-Stage Lung Adenocarcinoma With Consolidation Tumor Ratio Over 0.5

  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Qihai Sui
    Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Huiqiang Yang
    Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Jiacheng Yin
    Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Ming Li
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Xing Jin
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Zhencong Chen
    Correspondence
    Address for correspondence: Zhencong Chen, M.D. and Wei Jiang, M.D. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Wei Jiang
    Correspondence
    Address for correspondence: Zhencong Chen, M.D. and Wei Jiang, M.D. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Qun Wang
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
Published:August 14, 2022DOI:https://doi.org/10.1016/j.cllc.2022.08.005

      Abstract

      Introduction

      Surgery is the most effective treatment for early-stage lung cancer. This study will propose a personalized plan for mediastinal lymph node dissection in early-stage lung adenocarcinoma to reduce the risk of surgery and improve the quality of life.

      Methods

      This study retrospectively analyzed the patients underwent lobectomy and lymph node dissection in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical stage I lung adenocarcinoma patients with solid component ratio (CTR) between 0.5 and 1 were included. Patients were divided into systematic (S-MLND) and lobe-specific (L-MLND) mediastinal lymph node dissection groups. The days of hospitalization, the presence or absence of complications, the recurrence-free survival rate, and the overall survival rate were calculated to evaluate the postoperative quality and operation risk of the patients.

      Results

      210 patients (138 L-MLND and 72 S-MLND) were included. 2 lymph node metastases appeared in the S-MLND group while none in the L-MLND group (P = .049). No differences were shown in age, tumor site, size, solid component, degree of tumor invasion, and stage. The proportion of patients with severe postoperative cough and the length of hospital stay in the L-MLND group decreased. The 5-year OS of the entire cohort was 98.1%, 98.6% in L-MLND, compared with 97.2% in S-MLND; RFS was 94.8%, 95.7% in L-MLND, compared with 93.0% in S-MLND.

      Conclusion

      For cIA lung adenocarcinoma, according to the Thin-slice CT within 1 month before the operation, if the main lesion was less than 3 cm and CTR over 0.5, L-MLND is as effective as S-MLND.

      Keywords

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      Reference

        • Bray F
        • Ferlay J
        • Soerjomataram I
        • Siegel RL
        • Torre LA
        • Jemal A.
        Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2018; 68: 394-424
        • Bironzo P
        • Di Maio M.
        A review of guidelines for lung cancer.
        J Thorac Dis. 2018; 10 (Suppl): S1556-S1S63
        • Takenaka T
        • Katsura M
        • Shikada Y
        • Takeo S.
        Outcome of surgical resection as a first line therapy in T3 non-small cell lung cancer patients.
        World J Surg. 2013; 37: 2574-2580
        • S-i Watanabe
        • H Asamura
        Lymph node dissection for lung cancer: significance, strategy, and technique.
        J Thorac Oncol. 2009; 4: 652-657
        • Goya T
        • Asamura H
        • Yoshimura H
        • et al.
        Prognosis of 6644 resected non-small cell lung cancers in Japan: a Japanese lung cancer registry study.
        Lung Cancer. 2005; 50: 227-234
        • Naruke T
        • Tsuchiya R
        • Kondo H
        • Nakayama H
        • Asamura H.
        Lymph node sampling in lung cancer: how should it be done?.
        Eur J Cardio-Thorac Surg. 1999; 16 (Supplement_): S17-S24
        • Koike T
        • Koike T
        • Yamato Y
        • Yoshiya K
        • Toyabe S.
        Predictive risk factors for mediastinal lymph node metastasis in clinical stage IA non-small-cell lung cancer patients.
        J Thorac Oncol. 2012; 7: 1246-1251
        • Li M
        • Xi J
        • Zhang H
        • et al.
        Pan-driver-negatives versus epidermal growth factor receptor mutants for c-stage IA lung adenocarcinoma with ground-glass opacity.
        Ann Thorac Cardiovasc Surg. 2022; https://doi.org/10.5761/atcs.oa.22-00058
        • Yin J
        • Xi J
        • Liang J
        • et al.
        Solid components in the mediastinal window of computed tomography define a distinct subtype of subsolid nodules in clinical stage I lung cancers.
        Clin Lung Cancer. 2021; 22: 324-331
        • Travis WD
        • Asamura H
        • Bankier AA
        • et al.
        The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer.
        J Thorac Oncol. 2016; 11: 1204-1223
        • Hattori A
        • Matsunaga T
        • Takamochi K
        • Oh S
        • Suzuki K.
        Extent of mediastinal nodal dissection in stage I non-small cell lung cancer with a radiological pure-solid appearance.
        Eur J Surg Oncol. 2021; 47: 1797-1804
        • Cahan WG
        • Watson WL
        • Pool JL.
        Radical pneumonectomy.
        J Thorac Surg. 1951; 22: 449-473
        • Passlick B
        • Kubuschock B
        • Sienel W
        • Thetter O
        • Pantel K
        • Izbicki JR.
        Mediastinal lymphadenectomy in non-small cell lung cancer: effectiveness in patients with or without nodal micrometastases — results of a preliminary study.
        Eur J Cardio-Thorac Surg. 2002; 21: 520-526
        • Asamura H
        • Nakayama H
        • Kondo H
        • Tsuchiya R
        • Naruke T.
        Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis.
        J Thorac Cardiovasc Surg. 1999; 117: 1102-1111
        • Keller SM
        • Adak S
        • Wagner H
        • Johnson DH.
        Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group.
        Ann Thorac Surg. 2000; 70 (discussion 65-6): 358-365
        • Bollen EC
        • van Duin CJ
        • Theunissen PH
        • vt Hof-Grootenboer BE
        • Blijham GH.
        Mediastinal lymph node dissection in resected lung cancer: morbidity and accuracy of staging.
        Ann Thorac Surg. 1993; 55: 961-966
        • Oda M
        • Watanabe Y
        • Shimizu J
        • et al.
        Extent of mediastinal node metastasis in clinical stage I non-small-cell lung cancer: the role of systematic nodal dissection.
        Lung Cancer. 1998; 22: 23-30
        • Ma K
        • Chang D
        • He B
        • et al.
        Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer.
        J Cancer Res Clin Oncol. 2008; 134: 1289
        • Meng D
        • Zhou Z
        • Wang Y
        • Wang L
        • Lv W
        • Hu J.
        Lymphadenectomy for clinical early-stage non-small-cell lung cancer: a systematic review and meta-analysis.
        Eur J Cardio-Thorac Surg. 2016; 50: 597-604
        • Muraoka M
        • Akamine S
        • Oka T
        • et al.
        Sentinel node sampling limits lymphadenectomy in stage I non-small cell lung cancer.
        Eur J Cardio-Thorac Surg. 2007; 32: 356-361
        • Hattori A
        • Matsunaga T
        • Takamochi K
        • Oh S
        • Suzuki K.
        Prognostic impact of a ground glass opacity component in the clinical T classification of non–small cell lung cancer.
        J Thorac Cardiovas Surg. 2017; 154 (.e1): 2102-2110
        • Fan F
        • Zhang Y
        • Fu F
        • et al.
        Subsolid lesions exceeding 3 centimeters: the ground-glass opacity component still matters.
        Ann Thorac Surg. Mar 2022; 113: 984-992
        • Hattori A
        • Hirayama S
        • Matsunaga T
        • et al.
        Distinct clinicopathologic characteristics and prognosis based on the presence of ground glass opacity component in clinical stage IA lung adenocarcinoma.
        J Thorac Oncol. 2019; 14: 265-275
        • Aokage K
        • Miyoshi T
        • Ishii G
        • et al.
        Influence of ground glass opacity and the corresponding pathological findings on survival in patients with clinical stage I non–small cell lung cancer.
        J Thorac Oncol. 2018; 13: 533-542
        • Ye B
        • Cheng M
        • Li W
        • et al.
        Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma.
        Ann Thorac Surg. 2014; 98: 217-223
        • Fu F
        • Zhang Y
        • Wen Z
        • et al.
        Distinct prognostic factors in patients with stage I non–small cell lung cancer with radiologic part-solid or solid lesions.
        J Thorac Oncol. 2019; 14: 2133-2142
        • Jiang W
        • Pang X
        • Xi J
        • et al.
        Clinical outcome of subcentimeter non-small cell lung cancer after surgical resection: single institution experience of 105 patients.
        J Surg Oncol. 2014; 110: 233-238
        • Darling GE
        • Allen MS
        • Decker PA
        • et al.
        Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non–small cell carcinoma: Results of the American College of Surgery Oncology Group Z0030 Trial.
        J Thorac Cardiovasc Surg. 2011; 141: 662-670
        • Ray MA
        • Smeltzer MP
        • Faris NR
        • Osarogiagbon RU.
        Survival after mediastinal node dissection, systematic sampling, or neither for early stage NSCLC.
        J Thorac Oncol. 2020; 15: 1670-1681
        • Wu Y
        • Huang ZF
        • Wang SY
        • Yang XN
        • Ou W.
        A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer.
        Lung Cancer. 2002; 36: 1-6
        • Okada M
        • Sakamoto T
        • Yuki T
        • Mimura T
        • Miyoshi K
        • Tsubota N
        Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer.
        Ann Thorac Surg. 2006; 81: 1028-1032
        • Sun F
        • Zhan C
        • Shi M
        • et al.
        Is routine dissection of the station 9 lymph nodes really necessary for primary lung cancer?.
        Int J Surg. 2016; 34: 53-57
        • Wu J
        • Ohta Y
        • Minato H
        • et al.
        Nodal occult metastasis in patients with peripheral lung adenocarcinoma of 2.0 cm or less in diameter.
        Ann Thorac Surg. 2001; 71 (discussion 7-8): 1772-1777
        • Wang L
        • Jiang W
        • Zhan C
        • et al.
        Lymph node metastasis in clinical stage IA peripheral lung cancer.
        Lung Cancer. 2015; 90: 41-46
        • Okada M
        • Nakayama H
        • Okumura S
        • et al.
        Multicenter analysis of high-resolution computed tomography and positron emission tomography/computed tomography findings to choose therapeutic strategies for clinical stage IA lung adenocarcinoma.
        J Thorac Cardiovasc Surg. 2011; 141: 1384-1391
        • Reichert M
        • Steiner D
        • Kerber S
        • et al.
        A standardized technique of systematic mediastinal lymph node dissection by video-assisted thoracoscopic surgery (VATS) leads to a high rate of nodal upstaging in early-stage non-small cell lung cancer.
        Surg Endosc. 2016; 30: 1119-1125
        • Lardinois D
        • De Leyn P
        • Van Schil P
        • et al.
        ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer☆.
        Eur J Cardio-Thorac Surg. 2006; 30: 787-792
        • Merritt RE
        • Hoang CD
        • Shrager JB.
        Lymph node evaluation achieved by open lobectomy compared with thoracoscopic lobectomy for N0 lung cancer.
        Ann Thorac Surg. 2013; 96: 1171-1177
        • Wilson JL
        • Louie BE
        • Cerfolio RJ
        • et al.
        The prevalence of nodal upstaging during robotic lung resection in early stage non-small cell lung cancer.
        Ann Thorac Surg. 2014; 97 (discussion 6-7): 1901-1906