Clinical Pattern of Pulmonary Lymph Node Metastasis in Non-small Cell Lung Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CUIYue ¹ , YANGXiao-jun ² , XIETian-peng ² , XIANGRun ² ,  LIQiang ²

1. Department of Thoracic Surgery, First Affiliated Hospital of Kunming Medical University, Kunming 650000, P. R. China;
2. Department of Thoracic Surgery, Cancer Hospital of Sichuan Province, Chengdu 610041, P. R. China;

Corresponding author：

LIQiang, Email: liqiang201320@163.com

Keywords：

Non-small cell lung cancer; Pulmonary lymph node; Metastasis

DOI：

10.7507/1007-4848.20160235

Video：

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Objective To elucidate the clinical pattern of pulmonary lymph node metastasis and the significance of station No.12 and No. 13 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC). Methods Thirty-eight NSCLC patients underwent standard radical resection of pulmonary carcinoma and systemic lymphadenectomy between January 2015 and June 2015. There were 29 males and 9 females with a mean age of 61.1±15.4 years (ranged from 44 to 73 years). There were 20 patients of squamous carcinoma, 17 patients of adenocarcinoma and 1 patient of sarcomatoid carcinoma. All patients didn't receive radioor chemotherapy before the operation. All the lymph nodes in the surgical specimens were marked and sampled for pathology examination. Results We obtained 652 lymph nodes in total (17.2 per patient). Seventy-eight lymph nodes of 24 patients showed lymphatic metastasis with a metastasis degree of 12.0% (78/652) and a metastasis rate of 63.2% (24/38). Among which there were 22 patients of N₁ metastasis, 10 of N₁+N₂ and 2 of N₂ skipping metastasis. Routine pathological examination of N₁ metastasis demonstrated 12 patients of positive station No.12 and No.13 lymph nodes with the metastasis rate of 31.6%. The total amount of dissected lymph nodes was 95, among which there were 14 lymphatic metastasis with the metastasis rate of 14.7%. Four patients with nodal involvement in lymph node stations No.12 or No.13 were identified from 18 patients without mediastinal and intrapulmonary lymph node metastases confirmed by routine pathological examination. The detection rate was 22.2% (4/18) and the rate of N₁ missed diagnosis was 33.3% (4/12). Univariate and multivariate analysis suggested that the metastasis degree of pulmonary lymph nodes of station No.12 and No.13 was associated with tumor differentiation grade (χ²=6.453,P=0.011), while it didn't show any significant differences as to pathology subtype (χ²=0.118, P=0.732), tumor size (χ²=0.930, P=0.759), or tumor classification (χ²=1.648, P=0.199). Conclusion Pulmonary lymph node metastasis occupies an important place in the process of lung cancer metastasis. Patients with NSCLC especially those of poorly differentiated should be pathologically examined regularly in order to improve the accuracy of staging.

Citation： CUI Yue, YANG Xiao-jun, XIE Tian-peng, XIANG Run, LI Qiang. Clinical Pattern of Pulmonary Lymph Node Metastasis in Non-small Cell Lung Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(10): 982-987. doi: 10.7507/1007-4848.20160235 Copy

1.	Silvestri GA, Gould MK, Margolis ML, et al. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest, 2007,132(3Suppl): 178S-201S.
2.	Naruke T, Tsuchiya R, Kondo H, et al. Lymph node sampling in lung cancer: how should it be done?. Eur J Cardiothorac Surg, 1999, 16(Suppl 1): S17-S24.
3.	Mountain CF. Revisions in the international system for staging lung cancer. Chest, 1997, 111(6): 1710-1717.
4.	Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest, 1997, 111(6): 1718-1723.
5.	Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest, 2009, 136(1): 260-271.
6.	Yoshino I, Yokoyama H, YanoT, et al. Skip metastasis to the mediastinal lymph Nodes in non-small cell lung cancer. Ann Thorac Surg, 1996, 62(4): 1021-1025.
7.	Sun JK, Zhao CW, Weng PG. The Surgery of lung cancer. People's Medical Publishing House, 1987. 24-25.
8.	孙即昆, 主编. 肺外科学. 北京:人民卫生出版社, 1987. 24-25.
9.	Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. Thorac Cardiovasc Surg, 1978, 76(6): 832-839.
10.	Naruke T, Tsuchiya R, Kondo H, et al. Lymph node sampling in lung cancer: how should it be done? Eur J Cardiothorac Surg, 1999, 16(Suppl 1): S17-S24.
11.	高锐, 刘建阳, 张春江, 等.肺癌N1淋巴结分站清扫的临床意义. 中国实验诊断学, 2012, 16(2): 306-307.
12.	Nathanson SD. Insights into the mechanisms of lymph node metastasis. Cancer, 2003, 98(2): 413-423.
13.	HE Y, Rajantie I, Ilmonen M, et al. Preexisting lymphatic endothelium but not endothelial progenitor cells are essential for tumor lymphangiogenesis and lymphatic metastasis. Cancer Res, 2004, 64(11): 3737-3740.
14.	田界勇, 魏大中, 马冬春. 非小细胞肺癌淋巴结转移规律分析. 中国癌症杂志, 2012, 22(5): 285-288.
15.	陈福楠. 861例非小细胞肺癌淋巴结转移规律及临床意义. 福建医科大学, 2004.
16.	Jonnalagadda S, Smith C, Mhango G, et al. The number of lymph node metastases as a prognostic factor in patients with N1 nonsmall cell lung cancer. Chest, 2011, 140(2): 433.
17.	Sayar A, Turna A, Kilicgun A, et al. Prognostic significance of surgical-pathologic multiple-station N1 disease in non-small cell carcinoma of the lung. Eur J Cardiothorac Surg, 2004, 25(3): 434-438.
18.	Riquet M, Mordant P, Pricopi C, et al. A review of 250 ten-year survivors after pneumonectomy for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2014, 45(5): 876-881.
19.	Riquet M, Berna P, Arame A, et al. Lung cancer invading the fissure to the adjacent lobe: more a question of spreading mode than a staging problem. Eur J Cardiothorac Surg, 2012, 41(5): 1047-1051.
20.	Matsuoka H, Masaki T, Kobayashi T, et al. Morphological criteria for metastatic mesorectal lymph nodes in rectal cancer. Hepatogastroenterology, 2009, 56(96): 1661-1664.
21.	黄建, 王茂生, 梁宇强, 等. 肺癌淋巴结转移特点及转移方式的临床分析. 中国医师杂志, 2006, 8(2): 168-170.
22.	陆舜, 虞永峰, 吴春晓, 等. 淋巴结转移数和病灶大小在可手术非小细胞肺癌预后中的意义. 肿瘤, 2007, 27(12): 973-976.
23.	周华富, 何巍, 陈铭伍, 等. 非小细胞肺癌淋巴结转移规律的临床研究. 广西医科大学学报, 2005, 22(5): 694-697.
24.	罗凌青, 张建中, 崔海宁, 等.155 例肺癌患者淋巴结转移的临床研究. 中国肺癌杂志, 2007, 10(5): 422-424.
25.	王伦青, 张哲, 尹志, 等.原发性肺癌淋巴结清除临床价值的探讨. 中国肿瘤防治杂志, 2008, 15(18): 1408-1410.
26.	曾海, 钟亚华, 谢丛华, 等. 非小细胞肺癌(NSCLC)纵隔淋巴结转移规律探讨. 现代肿瘤医学, 2013, 21(2): 336-339.
27.	涂长玲, 张灿珍, 王昆, 等. 232例非小细胞肺癌患者淋巴结转移相关因素的临床分析. 现代肿瘤医学, 2009, 17(1): 58-59.

1. Silvestri GA, Gould MK, Margolis ML, et al. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest, 2007,132(3Suppl): 178S-201S.
2. Naruke T, Tsuchiya R, Kondo H, et al. Lymph node sampling in lung cancer: how should it be done?. Eur J Cardiothorac Surg, 1999, 16(Suppl 1): S17-S24.
3. Mountain CF. Revisions in the international system for staging lung cancer. Chest, 1997, 111(6): 1710-1717.
4. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest, 1997, 111(6): 1718-1723.
5. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest, 2009, 136(1): 260-271.
6. Yoshino I, Yokoyama H, YanoT, et al. Skip metastasis to the mediastinal lymph Nodes in non-small cell lung cancer. Ann Thorac Surg, 1996, 62(4): 1021-1025.
7. Sun JK, Zhao CW, Weng PG. The Surgery of lung cancer. People's Medical Publishing House, 1987. 24-25.
8. 孙即昆, 主编. 肺外科学. 北京:人民卫生出版社, 1987. 24-25.
9. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. Thorac Cardiovasc Surg, 1978, 76(6): 832-839.
10. Naruke T, Tsuchiya R, Kondo H, et al. Lymph node sampling in lung cancer: how should it be done? Eur J Cardiothorac Surg, 1999, 16(Suppl 1): S17-S24.
11. 高锐, 刘建阳, 张春江, 等.肺癌N1淋巴结分站清扫的临床意义. 中国实验诊断学, 2012, 16(2): 306-307.
12. Nathanson SD. Insights into the mechanisms of lymph node metastasis. Cancer, 2003, 98(2): 413-423.
13. HE Y, Rajantie I, Ilmonen M, et al. Preexisting lymphatic endothelium but not endothelial progenitor cells are essential for tumor lymphangiogenesis and lymphatic metastasis. Cancer Res, 2004, 64(11): 3737-3740.
14. 田界勇, 魏大中, 马冬春. 非小细胞肺癌淋巴结转移规律分析. 中国癌症杂志, 2012, 22(5): 285-288.
15. 陈福楠. 861例非小细胞肺癌淋巴结转移规律及临床意义. 福建医科大学, 2004.
16. Jonnalagadda S, Smith C, Mhango G, et al. The number of lymph node metastases as a prognostic factor in patients with N1 nonsmall cell lung cancer. Chest, 2011, 140(2): 433.
17. Sayar A, Turna A, Kilicgun A, et al. Prognostic significance of surgical-pathologic multiple-station N1 disease in non-small cell carcinoma of the lung. Eur J Cardiothorac Surg, 2004, 25(3): 434-438.
18. Riquet M, Mordant P, Pricopi C, et al. A review of 250 ten-year survivors after pneumonectomy for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2014, 45(5): 876-881.
19. Riquet M, Berna P, Arame A, et al. Lung cancer invading the fissure to the adjacent lobe: more a question of spreading mode than a staging problem. Eur J Cardiothorac Surg, 2012, 41(5): 1047-1051.
20. Matsuoka H, Masaki T, Kobayashi T, et al. Morphological criteria for metastatic mesorectal lymph nodes in rectal cancer. Hepatogastroenterology, 2009, 56(96): 1661-1664.
21. 黄建, 王茂生, 梁宇强, 等. 肺癌淋巴结转移特点及转移方式的临床分析. 中国医师杂志, 2006, 8(2): 168-170.
22. 陆舜, 虞永峰, 吴春晓, 等. 淋巴结转移数和病灶大小在可手术非小细胞肺癌预后中的意义. 肿瘤, 2007, 27(12): 973-976.
23. 周华富, 何巍, 陈铭伍, 等. 非小细胞肺癌淋巴结转移规律的临床研究. 广西医科大学学报, 2005, 22(5): 694-697.
24. 罗凌青, 张建中, 崔海宁, 等.155 例肺癌患者淋巴结转移的临床研究. 中国肺癌杂志, 2007, 10(5): 422-424.
25. 王伦青, 张哲, 尹志, 等.原发性肺癌淋巴结清除临床价值的探讨. 中国肿瘤防治杂志, 2008, 15(18): 1408-1410.
26. 曾海, 钟亚华, 谢丛华, 等. 非小细胞肺癌(NSCLC)纵隔淋巴结转移规律探讨. 现代肿瘤医学, 2013, 21(2): 336-339.
27. 涂长玲, 张灿珍, 王昆, 等. 232例非小细胞肺癌患者淋巴结转移相关因素的临床分析. 现代肿瘤医学, 2009, 17(1): 58-59.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Pattern of Pulmonary Lymph Node Metastasis in Non-small Cell Lung Cancer

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