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Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer

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Abstract

Purpose

To explore the appropriate method of mediastinal lymph node dissection for selected clinical stage IA (cIA) non-small cell lung cancer (NSCLC).

Methods

From 1998 through 2002, the curative-intent surgery was performed to 105 patients with cIA NSCLC who had been postoperatively identified as pathologic-stage T1. According to the method of intraoperative medistinal lymph node dissection, they were divided into radical systematic mediastinal lymphadenectomy (LA) group (n = 42) and mediastinal lymph-node sampling (LS) group (n = 63). The effects of LS and LA on morbidity, N staging, overall survival (OS) and disease-free survival (DFS) were investigated. Also, associations between clinicopathological parameters and survival were analyzed.

Results

The mean numbers of dissected lymph nodes per patient in the LA group was significantly greater than that in the LS group (15.59 ± 3.08 vs. 6.46 ± 2.21, P < 0.001), and the postoperative overall morbidity rate was higher in the LA group than that in the LS group (26.2 vs. 11.1%, P = 0.045). There were no significant difference in migration of N staging, OS and DFS between two groups. However, for patients with lesions between 2 and 3 cm, the 5-year OS in LA group was significantly higher than that in LS group (81.6 vs. 55.8%, P = 0.041), and the 5-year DFS was also higher (77.9 vs. 52.5%, P = 0.038). For patients with lesions of 2 cm or less, 5-year OS and DFS were similar in both groups. Multivariate analysis showed that lymph node metastasis was the unique unfavorable prognostic factor (P < 0.001).

Conclusions

After being intraoperatively identified as stage T1, patients with lesions between 2 and 3 cm in cIA NSCLC should be performed with LA to get a potentially better survival, and patients with lesions of 2 cm or less should be performed with LS to decrease invasion.

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Abbreviations

cIA:

Clinical stage IA

DFS:

Disease-free survival

LA:

Radical systematic mediastinal lymphadenectomy

LS:

Mediastinal lymph-node sampling

NSCLC:

Non-small cell lung cancer

OS:

Overall survival

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Kai Ma, Dong Chang, Min Gong, Feng Tian, Xiaodan Hu & Tianyou Wang

  2. Department of Thoracic Surgery, Qingdao Municiple Hospital, Qingdao, 266011, China

    Baoliang He & Zhongyi Ji

Authors
  1. Kai Ma
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  2. Dong Chang
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  3. Baoliang He
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  4. Min Gong
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  5. Feng Tian
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  6. Xiaodan Hu
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  7. Zhongyi Ji
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  8. Tianyou Wang
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Correspondence to Tianyou Wang.

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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 134, 1289–1295 (2008). https://doi.org/10.1007/s00432-008-0421-3

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  • DOI: https://doi.org/10.1007/s00432-008-0421-3

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