Abstract
Background
It remains unclear about the predictors and survival impact of station 4L metastasis in left-sided non-small cell lung cancer (NSCLC). This study aims to investigate these issues to explore the significance of station 4L lymph-node dissection (LND).
Methods
We retrospectively enrolled 405 patients with station 4L LND, and divided them into the positive station 4L metastasis group and the negative station 4L metastasis group. The logistic regression was performed to identify the predictors of station 4L metastasis. The survival outcomes including disease-free survival (DFS) and overall survival (OS) were analyzed in pN2 patients to explore the prognostic effect of station 4L metastasis.
Results
There were 48 (11.9%) patients in the positive station 4L metastasis group and 357 (88.1%) patients in the negative station 4L metastasis group. Station 5 metastasis (P = 0.008, OR 7.578, 95% CI 1.710–33.589), station 10 metastasis (P = 0.004, OR 7.133, 95% CI 1.904–26.717), and cN2 (P = 0.010, OR 5.062, 95% CI 1.473–17.392) were independent risk factors of station 4L metastasis. In pN2 patients, the positive station 4L metastasis group had inferior DFS (P = 0.019) and OS (P = 0.006) compared with the negative station 4L metastasis group, and station 4L metastasis was the independent risk factor for poor prognosis.
Conclusion
It is of great necessity to perform station 4L LND in left NSCLC, because station 4L metastasis is not rare and has an unfavorable prognosis.
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References
Adachi H, Sakamaki K, Nishii T et al (2017) Lobe-specific lymph node dissection as a standard procedure in surgery for non-small cell lung cancer: a propensity score matching study. J Thorac Oncol 12(1):85–93
Billiet C, De Ruysscher D, Peeters S et al (2016) Patterns of locoregional relapses in patients with contemporarily staged stage III-N2 NSCLC treated with induction chemotherapy and resection: implications for postoperative radiotherapy target volumes. J Thorac Oncol 11(9):1538–1549
Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424
Clement-Duchene C, Luc A, Casse JM et al (2018) Survival impact of stations of pathological lymph nodes in N2 non-small cell lung cancer in a French Hospital. Ann Surg Oncol 25(5):1262–1268
Darling GE, Allen MS, Decker PA et al (2011) 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 141(3):662–670
Feng W, Fu XL, Cai XW et al (2014) Patterns of local-regional failure in completely resected stage IIIA(N2) non-small cell lung cancer cases: implications for postoperative radiation therapy clinical target volume design. Int J Radiat Oncol Biol Phys 88(5):1100–1107
Han H, Chen H (2017) Selective lymph node dissection in early-stage non-small cell lung cancer. J Thorac Dis 9(7):2102–2107
Howington JA, Blum MG, Chang AC et al (2013) Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e278S–e313S
Johnson DH, Schiller JH, Bunn PA Jr (2014) Recent clinical advances in lung cancer management. J Clin Oncol 32(10):973–982
Kim HJ, Kim YH, Choi SH et al (2016) Video-assisted mediastinoscopic lymphadenectomy combined with minimally invasive pulmonary resection for left-sided lung cancer: feasibility and clinical impacts on surgical outcomesdagger. Eur J Cardiothorac Surg 49(1):308–313
Kuroda H, Sakao Y, Mun M et al (2015) Lymph node metastases and prognosis in left upper division non-small cell lung cancers: the impact of interlobar lymph node metastasis. PLoS One 10(8):e0134674
Liang RB, Yang J, Zeng TS et al (2018) Incidence and distribution of lobe-specific mediastinal lymph node metastasis in non-small cell lung cancer: data from 4511 resected cases. Ann Surg Oncol 24:3300–3307
Nagashima T (2016) Thoracoscopic left mediastinal lymph node dissection. Ann Transl Med 4(1):10
Postmus PE, Kerr KM, Oudkerk M et al (2017) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28(suppl 4):iv1–iv21
Rami-Porta R, Wittekind C, Goldstraw P et al (2005) Complete resection in lung cancer surgery: proposed definition. Lung Cancer 49(1):25–33
Rami-Porta R, Asamura H, Travis WD et al (2017) Lung cancer—major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 67(2):138–155
Reck M, Heigener DF, Mok T et al (2013) Management of non-small-cell lung cancer: recent developments. Lancet 382(9893):709–719
Rusch VW, Asamura H, Watanabe H et al (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 4(5):568–577
Sakao Y, Miyamoto H, Yamazaki A et al (2006) The spread of metastatic lymph nodes to the mediastinum from left upper lobe cancer: results of superior mediastinal nodal dissection through a median sternotomy. Eur J Cardiothorac Surg 30(3):543–547
Sayar A, Citak N, Buyukkale S et al (2016) The incidence of hoarseness after mediastinoscopy and outcome of video-assisted versus conventional mediastinoscopy in lung cancer staging. Acta Chir Belg 116(1):23–29
Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30
Takenaka T, Katsura M, Shikada Y et al (2013) Outcome of surgical resection as a first line therapy in T3 non-small cell lung cancer patients. World J Surg 37(11):2574–2580
Trujillo-Reyes JC, Martínez-Téllez E, Rami-Porta R et al (2018) Combination video-assisted mediastinoscopic lymphadenectomy and transcervical thoracoscopy. Multimed Man Cardiothorac Surg. https://doi.org/10.1510/mmcts.2018.004
Wang YN, Yao S, Wang CL et al (2018) Clinical significance of 4L lymph node dissection in left lung cancer. J Clin Oncol 36(29):2935–2942
Watanabe S, Asamura H (2009) Lymph node dissection for lung cancer: significance, strategy, and technique. J Thorac Oncol 4(5):652–657
Whitson BA, Groth SS, Maddaus MA (2007) Surgical assessment and intraoperative management of mediastinal lymph nodes in non-small cell lung cancer. Ann Thorac Surg 84(3):1059–1065
Yoo DG, Kim YH, Kim DK et al (2011) Clinical feasibility and surgical benefits of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer. Eur J Cardiothorac Surg 40(6):1483–1486
Funding
This study was funded by Major Science and Technology Projects of Zhejiang Province (2014C03032), Key Disciplines of Traditional Chinese Medicine in Zhejiang Province (2017-XK-A33), National Key R&D Program of China (2017YFC0113500), and National Natural Science Foundation of China (31700690). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Drs. JH and LF contributed to the conception and design of the work. Dr. LF and contributed to conception, design, data analysis, and editing the manuscript. Drs. LF, LW, YW, and YW contributed to data acquisition, statistical analysis, and interpretation of the data. Drs. PY and WL contributed to the revision of the manuscript.
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Fang, L., Wang, L., Wang, Y. et al. Predictors and survival impact of station 4L metastasis in left non-small cell lung cancer. J Cancer Res Clin Oncol 145, 1313–1319 (2019). https://doi.org/10.1007/s00432-019-02880-9
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DOI: https://doi.org/10.1007/s00432-019-02880-9