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Wang S, Bao X, Yang F, Shi H. Multiparametric evaluation of mediastinal lymph node metastases in clinical T0-T1c stage non-small-cell lung cancers. Eur J Cardiothorac Surg 2024; 65:ezae059. [PMID: 38429956 DOI: 10.1093/ejcts/ezae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/04/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES This study aimed to determine the predictive factors of lymph node metastases in clinical T0-T1c stage non-small-cell lung cancers, so as to help making surgical strategy. METHODS From January 2016 to December 2017, patients with clinical T0-T1c stage non-small-cell lung cancers were retrospectively reviewed. We elucidated the lymph node metastatic incidence and distribution according to the primary tumour radiographic findings and maximal standard uptake values, and extracted the associated clinicopathological factors. Univariable and multivariable logistic regressions were used to identify independent predictive parameters for lymph node metastases. The performance of predictive model was evaluated using receiver operating characteristic analysis. RESULTS A total of 517 patients were included. Seventy-two patients had lymph node metastases. Among patients with pure ground-glass nodule and solid component size ≤10 mm, none had any lymph node metastasis. Multivariable logistic regression analysis demonstrated that age, carcinoembryonic antigen level, solid component size, consolidation-tumour ratio and tumour maximal standard uptake values were independent predictors of lymph nodal metastases. Receiver operating characteristic analyses indicated that the area under the curve of predictive model in evaluating lymph node metastases was 0.838 (95% CI 0.791-0.886). CONCLUSIONS Younger age, elevated carcinoembryonic antigen level, larger solid component size, higher consolidation-tumour ratio and tumour maximal standard uptake values were associated with lymph node involvement. Employing such a predictive model in the future may affect the surgical option of lymph node excision for patients in cT1 stage non-small-cell lung cancer.
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Affiliation(s)
- Siyang Wang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Xiao Bao
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Feixing Yang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Institute of Nuclear Medicine, Fudan University, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
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2
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Mitsui S, Tanaka Y, Jimbo N, Doi T, Tane S, Hokka D, Maniwa Y. Programmed death ligand-1 expression and occult lymph node metastasis in non-small cell lung cancer. Thorac Cancer 2023. [PMID: 37160414 DOI: 10.1111/1759-7714.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Identifying the preoperative risk factors for lymph node upstaging could contribute to the development of individualized perioperative treatment for patients with non-small cell lung cancer (NSCLC). The current study aimed to evaluate the risk factors for lymph node upstaging, including gene mutation and programmed death ligand-1 expression in patients with resectable NSCLC. METHODS Data on the clinicopathological characteristics of patients who underwent lobectomy for clinical N0 NSCLC at our institution were collected. The clinicopathological findings of the pathological N0 and lymph node upstaging groups were then analyzed. Univariate and multivariate analyses were performed to examine the predictive factors for nodal upstaging. RESULTS Of 291 patients, 40 had postoperative nodal upstaging (n = 25, N1; n = 15, N2). Large tumor size and high maximum standardized uptake value were significantly associated with nodal upstaging. The nodal upstaging group had a higher proportion of patients with solid adenocarcinoma and lymphatic, vascular, and pleural invasion than the pathological N0 group. Further, the nodal upstaging group had a higher proportion of patients with positive programmed death ligand-1 expression than the pathological N0 group. Univariate and multivariate analyses showed that tumor size and positive programmed death ligand-1 expression were associated with nodal upstaging. CONCLUSION The appropriate therapeutic strategy including preoperative treatment and resection should be cautiously considered preoperatively in patients with clinical N0 NSCLC who have large tumors and positive programmed death ligand-1 expression.
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Affiliation(s)
- Suguru Mitsui
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoe Jimbo
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Tane
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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3
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Wang S, Xie S, Han Y, Gao M, Su X, Liu Q. Role of skip N2 lymph node metastasis for patients with the stage III-N2 lung adenocarcinoma: a propensity score matching analysis. BMC Pulm Med 2023; 23:147. [PMID: 37118722 PMCID: PMC10148388 DOI: 10.1186/s12890-023-02437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE Recent studies have indicated some differences in the prognosis of patients with stage III-N2 lung adenocarcinoma, and the prognosis of patients with skip N2 lymph node metastasis (SKN2) is good. This study grouped patients with stage III-N2 lung adenocarcinoma by propensity score matching (PSM) to evaluate the impact of SKN2 on the prognosis of these patients. METHODS The clinical data for patients who underwent radical lobectomy and had a postoperative pathological diagnosis of stage III-N2 lung adenocarcinoma at our centre from 2016 to 2018 were collected, and PSM was performed at a ratio of 1:1. RESULTS A total of 456 patients were enrolled in this study. After PSM, 112 patients were included in the SKN2 group, and 112 patients were included in the non-SKN2 group. When comparing the SKN2 group with the non-SKN2 group, the 3-year OS rate was (71.4% vs. 12.5%, p < 0.001), and the 3-year DFS rate was (35.7% vs. 5.4%, p < 0.001). It is further divided into four groups:single-station SKN2 (N2a1),Multi-station SKN2 (N2a2),single-station non-SKN2 (N2b1) and Multi-station non-SKN2 (N2b2).The 3-year OS and DFS rates of skip lymph node metastasis were better than those of non-skip lymph node metastasis(OS:N2a1 vs. N2b1 68.4% vs. 23.5%,p < 0.001;N2a2 vs. N2b2 73.0% vs. 7.7%,p < 0.001)(DFS:N2a1 vs. N2b1 68.4% vs. 5.9%,p < 0.001;N2a2 vs. N2b2 62.2% vs. 5.1%,p < 0.001), regardless of the number of N2 station(OS:N2a1 vs. N2a2 68.4% vs. 73.0%,p = 0.584;N2b1 vs. N2b2 23.5% vs. 7.7%,p = 0.051). On multivariate analysis, sex (p = 0.008) ,Vascular tumour thrombus(p = 0.047),size(p = 0.002)and SKN2 (p < 0.001) were independent predictors of OS. CONCLUSION For patients with stage III-N2 lung adenocarcinoma, the prognosis of SKN2 patients is better than non-SKN2 patients', and SKN2 may be used as an important factor in the N2 subgroup classification in future TNM staging.
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Affiliation(s)
- Shize Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shaonan Xie
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaqing Han
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Maogang Gao
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin Su
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingyi Liu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
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Li J, Lin X, Li X, Zhang W, Sun D. Somatic mutations combined with clinical features can predict the postoperative prognosis of stage IIIA lung adenocarcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:187. [PMID: 35280419 PMCID: PMC8908182 DOI: 10.21037/atm-22-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
Background Prognostic factors for stage IIIA lung adenocarcinoma (LUAD) are unclear. The current main treatment for stage IIIA LUAD is still controversial. Some Clinicians advocate synchronous chemoradiotherapy as the main treatment for stage IIIA LUAD. In contrast, some clinicians argue that there are still certain patients with stage IIIA LUAD who have a better postoperative prognosis. This study aimed to analyze preoperative factors as well as the association between somatic mutations and prognosis in stage IIIA LUAD [including overall survival (OS) time and the risk of postoperative recurrence]. Methods This study retrospectively reviewed the data of patients with stage IIIA LUAD who underwent radical resection of lung cancer in the thoracic surgery department of Tianjin Chest Hospital from January 01, 2011 to September 30, 2016. All patients involved in the study provided written informed consent. The associations between OS and DFS and the clinical characteristics as well as somatic mutations of patients were analyzed separately. The Kaplan-Meier method was used for univariate analysis, and survival curves were drawn. Multivariate analysis was performed by the Cox regression model. Results For univariate analysis, the prognostic factors of OS were the level of preoperative CYFRA21-1, the number of metastatic lymph node stations (NMLS), maximum tumor diameter, EGFR (epidermal growth factor receptor) classical base mutations, and the number of copies of POLE (polymerase epsilon) mutation (NCPM). Preoperative total protein level, preoperative CYFRA21-1 level, the number of metastatic lymph nodes (NMLN), maximum tumor diameter, the number of mutated genes (NMG) in tumor samples, TP53 mutations, and the number of copies of POLE mutation (NCPM) were associated with disease-free survival (DFS). The multivariate analysis showed that the preoperative CYFRA21-1 level, the number of metastatic lymph node stations (NMLS), and EGFR typical base mutations were independent prognostic factors of OS. The number of mutated genes (NMG), EGFR classical base mutations, preoperative NSE level, maximum tumor diameter, and the number of metastatic lymph node stations (NMLS) were independent prognostic factors for DFS. Conclusions The preoperative level of tumor markers, the number of metastatic lymph node stations, and EGFR typical base mutations are important factors for the prognosis of patients with resectable stage IIIA LUAD.
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Affiliation(s)
- Jiuzhen Li
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | | | - Xin Li
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Weiran Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Daqiang Sun
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China
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5
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Saygideger Y, Avci A, Bagir E, Saygıdeğer Demir B, Sezan A, Ekici M, Baydar O, Erkin ÖC. Slug and Vimentin downregulation at the metastatic site is associated with Skip-N2 metastasis of lung adenocarcinoma. Discov Oncol 2022; 13:7. [PMID: 35201505 PMCID: PMC8783939 DOI: 10.1007/s12672-022-00467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Lung cancer displays heterogeneity both in the tumor itself and in its metastatic regions. One interesting behavior of the tumor is known as Skip N2 metastasis, which N2 lymph nodes contain tumor cells while N1 are clean. In this study, mRNA levels of epithelial mesenchymal transition (EMT) related genes in skip N2 and normal N2 involvements of non-small cell lung cancer tissues were investigated to evaluate the possible molecular background that may contribute to the pathogenesis of Skip N2 metastasis. MATERIALS AND METHODS Eighty-three surgically resected and paraffin embedded lymph node samples of lung cancer patients were analyzed in this study, which 40 of them were Skip N2. N2 tissues were sampled from 50% tumor containing areas and total RNA was extracted. mRNA levels for 18S, E-cadherin, Vimentin, ZEB1 and SLUG were analyzed via qPCR and E-cadherin and vimentin protein levels via immunohistochemistry (IHC). Bioinformatic analysis were adopted using online datasets to evaluate significantly co-expressed genes with SLUG in lung cancer tissue samples. RESULTS Skip-N2 patients who had adenocarcinoma subtype had better survival rates. Comparative analysis of PCR results indicated that Skip N2 tumor tissues had increased E-Cadherin/Vimentin ratio and ZEB1 mRNA expression, and significantly decreased levels of SLUG. E-cadherin IHC staining were higher in Skip N2 and Vimentin were in Non-Skip N2. TP63 had a strong correlation with SLUG expression in the bioinformatics analyses. CONCLUSION The results indicate that, at molecular level, Skip N2 pathogenesis has different molecular background and regulation of SLUG expression may orchestrate the process.
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Affiliation(s)
- Yasemin Saygideger
- Department of Pulmonary, Cukurova University School of Medicine, Adana, Turkey.
- Institute of Health Sciences, Department of Translational Medicine, Cukurova University, Adana, Turkey.
| | - Alper Avci
- Department of Thoracic Surgery, Cukurova University School of Medicine, Adana, Turkey
| | - Emine Bagir
- Department of Pathology, School of Medicine, Cukurova University, Adana, Turkey
| | - Burcu Saygıdeğer Demir
- Department of Biotechnology, Institute of Natural and Applied Sciences, Cukurova University, Adana, Turkey
| | - Aycan Sezan
- Department of Biotechnology, Institute of Natural and Applied Sciences, Cukurova University, Adana, Turkey
| | - Mucahit Ekici
- Department of Pulmonary, Cukurova University School of Medicine, Adana, Turkey
| | - Oya Baydar
- Department of Pulmonary, Cukurova University School of Medicine, Adana, Turkey
| | - Özgür Cem Erkin
- Department of Bioengineering, Faculty of Engineering, Adana Alparslan Türkeş Science and Technology University, Adana, Turkey
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Wang X, Guo H, Hu Q, Ying Y, Chen B. The Impact of Skip vs. Non-Skip N2 Lymph Node Metastasis on the Prognosis of Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:749156. [PMID: 34712694 PMCID: PMC8546110 DOI: 10.3389/fsurg.2021.749156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: The skip N2 metastases were frequent in non-small-cell lung cancer (NSCLC) and the better prognosis of NSCLC with a skip over non-skip N2 lymph node metastases is controversial. The primary aim of this study is to investigate the prognosis effect of skip N2 lymph node metastases on the survival of NSCLC. Setting: A literature search was conducted in PubMed, EMBASE, and Cochrane Library with the term of “N2” or “mediastinal lymph node” or “mediastinal nodal metastases”, and “lung cancer” and “skip” or “skipping” in the title/abstract field. The primary outcomes of interests are 3- and 5-year survival in NSCLC. Participants: Patients who underwent complete resection by lobectomy, bilobectomy, or pneumonectomy with systemic ipsilateral lymphadenectomy and were staged as pathologically N2 were included. Primary and Secondary Outcome Measures: The 3- and 5-year survival of NSCLC was analyzed. The impact of publication year, number of patients, baseline mean age, gender, histology, adjuvant therapy, number of skip N2 stations, and survival analysis methods on the primary outcome were also analyzed. Results: A total of 21 of 409 studies with 6,806 patients met the inclusion criteria and were finally included for the analysis. The skip N2 lymph node metastases NSCLC had a significantly better overall survival (OS) than the non-skip N2 NSCLC [hazard ratio (HR), 0.71; 95% CI, 0.62–0.82; P < 0.001; I2 = 40.4%]. The skip N2 lymph node metastases NSCLC had significantly higher 3- and 5-year survival rates than the non-skip N2 lymph node metastases NSCLC (OR, 0.75; 95% CI, 0.66–0.84; P < 0.001; I2 = 60%; and OR, 0.78; 95% CI, 0.71–0.86; P < 0.001; I2 = 67.1%, respectively). Conclusion: This meta-analysis suggests that the prognosis of skip N2 lymph node metastases NSCLC is better than that of a non-skip N2 lymph node.
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Affiliation(s)
- Xinxin Wang
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Haixie Guo
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Quanteng Hu
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Yongquan Ying
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
| | - Baofu Chen
- Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China
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7
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Seyrek Y, Cansever L, Akın H, Metin M, Bolat E, Bedirhan MA. The Significance of Skip Mediastinal Lymph Node Metastasis in the Prognosis of Patients with Resected Non-Small-Cell Lung Carcinoma: Is It Really a Better N2 Disease Subtype? Ann Thorac Cardiovasc Surg 2021; 27:304-310. [PMID: 33790147 PMCID: PMC8560541 DOI: 10.5761/atcs.oa.20-00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: In this study, we aimed to reveal the prognostic differences between skip and non-skip metastasis mediastinal lymph node (MLN) metastasis. Methods: A total of 202 patients (179 males and 23 females; mean age, 59.66 ± 9.89 years; range: 29–84 years) who had ipsilateral single-station MLN metastasis were analyzed in two groups retrospectively between January 2009 and December 2017: “skip ipsilateral MLN metastasis” group (sN2) (n = 55,27.3%) [N1(–), N2(+)], “non-skip ipsilateral MLN metastasis” group (nsN2) (n = 147,72.7%) [N1(+), N2(+)]. Results: The mean follow-up was 42.63 ± 34.91 months (range: 2–117 months). Among all patients, and in the sN2 and nsN2 groups, the median overall survival times were 63.5 ± 4.56, 68.8 ± 7, and 59.3 ± 5.35 months, respectively, and the 5-year overall survival rates were 38.2%, 46.3%, and 36.4%. Conclusion: Skip metastasis did not take its rightful place in TNM classification; thus, further studies will be performed. To detect micrometastasis, future studies on skip metastasis should examine non-metastatic hilar lymph nodes (LNs) through staining methods so that heterogeneity in patient groups can be avoided, that is, to ensure that only true skip metastasis cases are included. Afterwards, more accurate and elucidative studies on skip metastasis can be achieved to propound its prognostic importance in the group of N2 disease.
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Affiliation(s)
- Yunus Seyrek
- Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey
| | - Levent Cansever
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
| | - Hasan Akın
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
| | - Erkut Bolat
- Department of Biostatistics and Medical Informatics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Ali Bedirhan
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Health Sciences University, Istanbul, Turkey
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8
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Wang Z, Cheng J, Huang W, Cheng D, Liu Y, Pu Q, Reticker-Flynn NE, Liu L. Skip metastasis in mediastinal lymph node is a favorable prognostic factor in N2 lung cancer patients: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:218. [PMID: 33708845 PMCID: PMC7940896 DOI: 10.21037/atm-20-3513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Skip metastasis is a common lymph node metastatic pattern in non-small cell lung cancer (NSCLC). The relationship between skip metastasis and specific clinicopathologic factors and the prognostic value of skip metastasis are controversial. Methods A systematic search and analysis of skip metastasis in NSCLC was conducted in the databases of PubMed, EMBASE, and Web of Science up to Dec 2019. Summarized hazard ratio (HR), mean difference (MD), and odds ratio (OR) with associated 95% confidence intervals (CI) were evaluated to investigating the relationship between skip metastasis and overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS) and clinicopathological features in NSCLC. Results 29 studies with a total of 1,806 skip and 4,670 non-skip N2 patients were included. The upper lobe tumor showed a higher rate of skip metastasis compared with lower lobe one (RR =1.16, 95% CI: 1.00–1.34, P=0.044, I2=39.8%). The presence of skip metastasis correlated with superior overall survival (HR =0.74, 95% CI: 0.66–0.83, P<0.001, I2=48.2%) and DFS or RFS (HR =0.71, 95% CI: 0.61–0.84, P<0.001, I2=18.2%). Further subgroup analyses indicated similar results in articles that reported intrapulmonary lymph node dissection (HR =0.67, 95% CI: 0.57–0.77, P<0.001, I2=0). Conclusions The results indicate that the presence of skip metastasis is associated with a marked increase in survival of NSCLC patients compared to patients with non-skip N2 metastasis. These results suggest that skip metastasis might be a distinct subgroup for purposes of N staging of NSCLC patients, and intrapulmonary lymph node assessment is needed.
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Affiliation(s)
- Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiahan Cheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China.,Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA, USA.,Stanford Blood Center, Palo Alto, CA, USA
| | - Wenyu Huang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Diou Cheng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yilin Liu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Nathan E Reticker-Flynn
- Department of Pathology, School of Medicine, Stanford University, Palo Alto, CA, USA.,Stanford Blood Center, Palo Alto, CA, USA
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
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9
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Wu Y, Han C, Gong L, Wang Z, Liu J, Liu X, Chen X, Chong Y, Liang N, Li S. Metastatic Patterns of Mediastinal Lymph Nodes in Small-Size Non-small Cell Lung Cancer (T1b). Front Surg 2020; 7:580203. [PMID: 33195388 PMCID: PMC7536402 DOI: 10.3389/fsurg.2020.580203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Lymph node metastasis (LNM) status is critical to the treatment. Fewer studies has focused on LNM in patients with small-size non-small cell lung cancer (NSCLC). This study aims to investigate clinicopathological characteristics associated with skip N2 (SN2) and non-skip N2 (NSN2) metastasis, and their metastatic patterns in NSCLC with tumor size of 1–2 cm. Methods: We reviewed the records of NSCLC patients with tumor size of 1–2 cm who underwent lobectomy with systematic lymph node dissection (LND) between January 2013 and June 2019. Clinical, radiographical, and pathological characteristics were compared among N1, SN2, and NSN2 groups. Metastatic patterns of mediastinal lymph node were analyzed based on final pathology. Results: A total of 63 NSCLC patients with tumor size of 1–2 cm were staged as pN2, including 25 (39.7%) SN2 and 38 (60.3%) NSN2. The incidence rates of SN2 and NSN2 were 2.8% (25/884) and 4.3% (38/884), respectively. For all clinicopathological characteristics, no significant difference was observed among the groups of N1, SN2, and NSN2. For the tumor located in each lobe, specific nodal drainage stations were identified: 2R/4R for right upper lobe; 2R/4R and subcarinal node (#7) for right middle lobe and right lower lobe; 4L and subaortic node (#5) for left upper lobe; #7 for left lower lobe. However, there were still a few patients (10.9%, 5/46) had the involvement of lower zone for tumors of upper lobe and the involvement of upper zone for lower lobe. Conclusions: SN2 occurs frequently in patients with small-size NSCLC. Whether lobe-specific selective LND is suitable for all small-size patients deserves more studies to confirm. Surgeons should be more careful when performing selective LND for tumors located in the lower and upper lobes.
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Affiliation(s)
- Yijun Wu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Chang Han
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Gong
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhile Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianghao Liu
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinyu Liu
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China.,Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xinyi Chen
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuming Chong
- Peking Union Medical College, Eight-year MD program, Chinese Academy of Medical Sciences, Beijing, China
| | - Naixin Liang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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10
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Lu Y, Ma T, Wang L, Xue T. [Advances in Lymph Node Metastasis and Lymph Node Dissection
in Early Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 22:520-525. [PMID: 31451143 PMCID: PMC6717872 DOI: 10.3779/j.issn.1009-3419.2019.08.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
肺癌是目前我国发病率和死亡率均居首位的恶性肿瘤,其中以非小细胞肺癌为主要病理类型。淋巴结转移是非小细胞肺癌最常见和最主要的转移途径,也是影响肺癌分期和预后最重要的因素。由于目前通过现有手段术前很难准确判断早期非小细胞肺癌患者的淋巴结受累情况。因此,在早期非小细胞肺癌中,尤其是在临床Ⅰ期非小细胞肺癌患者中,淋巴结清扫方式一直存在很大争议。本文就非小细胞肺癌淋巴结转移的规律及清扫方式进行综述。
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Affiliation(s)
- Yun Lu
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
| | - Teng Ma
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
| | - Lei Wang
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
| | - Tao Xue
- Department of Cardiothoracic Surgery, the Affiliated Zhongda Hospital of Southeast University, Nanjing 210000, China
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Guerrera F, Lococo F, Evangelista A, Rena O, Ampollini L, Vannucci J, Errico L, Lausi PO, Ventura L, Marchese V, Paci M, Filosso PL, Oliaro A, Casadio C, Puma F, Ruffini E, Ardissone F. Risk of recurrence in stage I adenocarcinoma of the lung: a multi-institutional study on synergism between type of surgery and type of nodal staging. J Thorac Dis 2019; 11:564-572. [PMID: 30963001 DOI: 10.21037/jtd.2019.01.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In last years, an increasing interest emerges on the role of sub-lobar resection and lobe-specific lymph nodal dissection in the treatment of early-stage lung cancer. The aim of our study was to define the impact on cumulative incidence of recurrence (CIR) of type of surgical resection and type of nodal staging in this subset of patients. Furthermore, we evaluated the possible synergism between the different kinds of procedure. Methods An analysis of 969 consecutive stage I pulmonary adenocarcinoma patients, operated in six Thoracic Surgery Institutions between 2001 and 2013, was conducted. Type of surgical resection included lobectomy and sub-lobar resection; while pneumonectomy and bilobectomy were excluded from the analysis. Nodal staging procedures were classified in nodal sampling (NS), lobe-specific lymph node dissection (LS-ND) and systematic lymph node dissection (SND). Multivariable-adjusted comparisons for CIR was performed using Fine and Grey model, taking into account of death by any cause as competing event. In order to evaluate synergism between the different procedures, the test of interaction between type of surgical resection and type of nodal staging was carried out and results presented in a stratified way. Results Eight-hundred forty-six (87%) patients were submitted to lobectomy, while 123 (13%) to sub-lobar resection. Four-hundred fifty-five (47%) patients received SND, 98 (10%) LS-ND and 416 (43%) NS. Two-hundred forty-seven (26%) patients developed a local/distant recurrence with a 5-year CIR of 24.2%. Multivariable-adjusted comparisons showed an independent negative effect of sub-lobar resection (HR =1.52; 95% CI: 1.07-2.17), LS-ND (HR =1.74; 95% CI: 1.16-2.6) and NS (HR =1.49; 95% CI: 1.12-1.98) on CIR. Test of interaction showed a homogeneity of results among subgroups. Conclusions Patients affected by stage I pulmonary adenocarcinoma and submitted to lobectomy presented a significant lower recurrence rate than those submitted to sub-lobar resection. Moreover, SND presented an independent positive effect on recurrence development than other lymph node assessment strategy. Finally, lobectomy in combination with systematic lymph nodal resection showed the best results in term of CIR.
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Affiliation(s)
- Francesco Guerrera
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, IRCCS - Ospedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ottavio Rena
- Department of Thoracic Surgery, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Luca Ampollini
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Luca Errico
- Department of Thoracic Surgery, San Luigi Hospital, Orbassano, Italy
| | - Paolo Olivo Lausi
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luigi Ventura
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | | | - Massimiliano Paci
- Department of Thoracic Surgery, IRCCS - Ospedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Pier Luigi Filosso
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alberto Oliaro
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Caterina Casadio
- Unit of Clinical Epidemiology, CPO, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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12
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Role of Skip Mediastinal Lymph Node Metastasis for Patients With Resectable Non-small-cell Lung Cancer: A Propensity Score Matching Analysis. Clin Lung Cancer 2018; 20:e346-e355. [PMID: 30665872 DOI: 10.1016/j.cllc.2018.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 08/31/2018] [Accepted: 12/09/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND N2 disease represents a heterogeneous group of non-small-cell lung cancer (NSCLC) with varying 5-year overall survival (OS) rates. The skip N2 phenomenon is quite frequent, and its prognostic impact remains a matter of debate. The aim of this study is to further assess the clinical significance and prognostic value of skip N2 disease using propensity score matching. PATIENTS AND METHODS The study cohort included 437 patients with stage pN2 NSCLC who underwent resection from 2005 to 2011. Differences in clinicopathologic characteristics were identified in the overall cohort. The effect of skip N2 on OS was assessed, stratified by histology, tumor size, N2 involved stations, and T stage after propensity score matching. RESULTS A total of 130 patients had skip N2 diseases in our study. Skip N2 metastasis was associated with age, tumor size, histology, and number of involved N2 stations. Matching of 130 pairs of patients showed that skip N2 was associated with a significantly better 5-year OS rate when compared with non-skip N2 disease (42.7% vs. 25.3%; P = .004), and OS is significantly better in the patients with tumor size of ≤ 3 cm (P = .014) or patients with single N2 station involvement (P = .002). Skip N2 conferred a significantly better OS in stage IIIA (P = .026) and IIIB (P = .029) disease. CONCLUSION The presence of skip N2 metastasis was a good prognostic factor of resectable N2 disease. N2 disease may be classified into more subgroups in the revision of the current tumor-lymph node-metastasis (TNM) system.
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Renaud S, Seitlinger J, Guerrera F, Reeb J, Beau-Faller M, Voegeli AC, Siat J, Clément-Duchêne C, Tiotiu A, Santelmo N, Costardi L, Ruffini E, Falcoz PE, Vignaud JM, Massard G. Prognostic Value of Exon 19 Versus 21 EGFR Mutations Varies According to Disease Stage in Surgically Resected Non-small Cell Lung Cancer Adenocarcinoma. Ann Surg Oncol 2018; 25:1069-1078. [DOI: 10.1245/s10434-018-6347-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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14
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Filosso PL, Guerrera F, Lausi PO, Ruffini E. Locally advanced non-small cell lung cancer treatment: another step forward. J Thorac Dis 2018; 9:4908-4911. [PMID: 29312689 DOI: 10.21037/jtd.2017.11.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | | | - Paolo Olivo Lausi
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, University of Torino, Torino, Italy
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15
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, Sacro Cuore-Don Calabria Research Hospital and Cancer Care Centre Negrar-Verona, Verona, Italy
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy University Hospital, Nancy, France
| | - Francesco Guerrera
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Surgical Sciences, University of Torino, Torino, Italy
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