Analysis of mediastinal lymph node metastasis of stage cT1a-cN0M0 lung adenocarcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Zhenrong ¹ , FENG Hongxiang ¹ , LIU Zhan ² , SHAO Weipeng ² , GU Xinlei ³ ,  LIU Deruo ¹

1. Department of General Thoracic Surgery, China-Japan Friendship Hospital, Beijing, 100029, P.R.China;
2. Department of General Thoracic Surgery, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, P.R.China;
3. Department of Thoracic Surgery, Peking University International Hospital, Beijing, 102206, P.R.China;

Corresponding author：

LIU Deruo, Email: deruoliu@vip.sina.com

Keywords：

Lung cancer; adenocarcinoma; lymph node metastasis; high resolution computed tomography

DOI：

10.7507/1007-4848.202002020

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Objective To investigate the mediastinal lymph node metastasis of cT1a-cN0M0 lung adenocarcinoma, so as to provide a theoretical basis for intraoperative lymph node dissection in patients with early stage lung adenocarcinoma.Methods Clinicopathological features of lung adenocarcinoma patients who received operation in our hospital from 2017 to 2018 were collected. A total of 667 patients including 241 male and 426 female patients at age of 59 (16, 87) years were included. There were 234 patients with pure ground glass nodules, 98 patients with ground glass-predominant tumor, 199 patients with consolidation-predominant tumor and 136 patinets with solid tumor in the study. Postoperative N1 lymph node metastasis occurred in 30 patients and N2 lymph node metastasis occurred in 52 patients.Results The result of univariate analysis showed that male (P=0.014), higher carcino-embryonic antigen levels (P<0.001), larger nodal diameter (P<0.001), larger consolidation tumor ratio (P<0.001), smaller tumor disappearance ratio (P<0.001), solid nodules (P<0.001), cavitary sign (P=0.005), lobulation sign (P=0.002), spicule sign (P=0.003), pleural indentation sign (P=0.001), bronchus sign (P=0.025) were risk factors for mediastinal lymph node metastasis. In terms of pathology, the N2 positive group had larger size of pathological tissue (P<0.001), more N1 lymph node metastasis (P<0.001), higher pathology T stage (P<0.001), more spread through air space (P=0.001), more pleural invasion (P<0.001), and more lymphovascular invasion (P<0.001). Multivariate analysis showed that lymphovascular invasion (OR=6.9, 95%CI 2.3-20.7, P=0.001), larger consolidation tumor ratio (OR=109.6, 95%CI 3.8-3 124.3, P=0.006), cavitary sign (OR=3.1, 95%CI 1.1-8.3, P=0.028) and N1 lymph node metastasis (OR=15.7, 95%CI 6.7-36.4, P<0.001) were independent risk factors for mediastinal lymph node metastasis.Conclusion For lung adenocarcinoma, mediastinal lymph node metastasis will not occur in ground glass nodule and ground glass-predominant tumor patients. The probability of mediastinal lymph node metastasis increases with the increase of solid components and presence of cavitary sign. Therefore, different types of lymph node resection can be considered for patients with different imaging findings.

Citation： ZHANG Zhenrong, FENG Hongxiang, LIU Zhan, SHAO Weipeng, GU Xinlei, LIU Deruo. Analysis of mediastinal lymph node metastasis of stage cT1a-cN0M0 lung adenocarcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(10): 1187-1193. doi: 10.7507/1007-4848.202002020 Copy

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1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-623.
2. Ye T, Deng L, Wang S, <italic>et al</italic>. Lung adenocarcinomas manifesting as radiological part-solid nodules define a special clinical subtype. J Thorac Oncol, 2019, 14(4): 617-627.
3. Matsunaga T, Suzuki K, Takamochi K, <italic>et al</italic>. What is the radiological definition of part-solid tumour in lung cancer? Eur J Cardiothorac Surg, 2017, 51(2): 242-247.
4. Goldstraw P, Chansky K, Crowley J, <italic>et al</italic>. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
5. Travis WD, Brambilla E, Nicholson AG, <italic>et al</italic>. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac oncol, 2015, 10(9): 1243-1260.
6. Chen B, Wang X, Yu X, <italic>et al</italic>. Lymph node metastasis in Chinese patients with clinical T1 non-small cell lung cancer: A multicenter real-world observational study. Thorac Cancer, 2019, 10(3): 533-542.
7. 张真榕, 冯宏响, 张耀文, 等. 病理 T1 期非小细胞肺癌淋巴结转移规律. 中日友好医院学报, 2015, 29(1): 15-18.
8. Watanabe S, Oda M, Go T, <italic>et al</italic>. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg, 2001, 20(5): 1007-1011.
9. Aokage K, Saji H, Suzuki K, <italic>et al</italic>. A non-randomized confirmatory trial of segmentectomy for clinical T1N0 lung cancer with dominant ground glass opacity based on thin-section computed tomography (JCOG1211). Gen Thorac Cardiovasc Surg, 2017, 65(5): 267-72.
10. De Leyn P, Lardinois D, Van Schil P, <italic>et al</italic>. European trends in preoperative and intraoperative nodal staging: ESTS guidelines. J Thorac Oncol, 2007, 2(4): 357-361.
11. Travis WD, Brambilla E, Noguchi M, <italic>et al</italic>. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary. Proc Am Thorac Soc, 2011, 8(5): 381-385.
12. Ye B, Cheng M, Li W, <italic>et al</italic>. Predictive factors for lymph node metastasis in clinical stageⅠA lung adenocarcinoma. Ann Thorac Surg, 2014, 98(1): 217-223.
13. Tsutani Y, Miyata Y, Mimae T, <italic>et al</italic>. The prognostic role of pathologic invasive component size, excluding lepidic growth, in stageⅠlung adenocarcinoma. J Thorac Cardiovasc Surg, 2013, 146(3): 580-585.
14. Chen K, Yang F, Jiang G, <italic>et al</italic>. Development and validation of a clinical prediction model for N2 lymph node metastasis in non-small cell lung cancer. Ann Thorac Surg, 2013, 96(5): 1761-1768.
15. Farjah F, Lou F, Sima C, <italic>et al</italic>. A prediction model for pathologic N2 disease in lung cancer patients with a negative mediastinum by positron emission tomography. J Thorac Oncol, 2013, 8(9): 1170-1180.
16. Watanabe Y, Kusumoto M, Yoshida A, <italic>et al</italic>. Surgically resected solitary cavitary lung adenocarcinoma: association between clinical, pathologic, and radiologic findings and prognosis. Ann Thorac Surg, 2015, 99(3): 968-974.

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Analysis of mediastinal lymph node metastasis of stage cT1a-cN0M0 lung adenocarcinoma

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