Efficacy of systematic versus lobe-specific lymph node dissection in the treatment of clinicalⅠA stage lung adenocarcinoma: A propensity score matching study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YI Tengfei ¹ , QIN Kun ² , SHAO Shengteng ¹ , LI Shuo ¹ ,  LIU Yuhong ¹

1. Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266071, Shandong, P. R. China;
2. Department of Emergency Surgery, Affiliated Hospital of Qingdao University, Qingdao, 266071, Shangdong, P. R. China;

Corresponding author：

LIU Yuhong, Email: qdlyuhong@sohu.com

Keywords：

Clinical ⅠA stage lung adenocarcinoma; systematic lymph node dissection; lobe-specific lymph node dissection; prognosis

DOI：

10.7507/1007-4848.202111046

Video：

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Objective To analyze the effects of systematic lymph node dissection (SLND) and lobe-specific lymph node dissection (L-SND) on perioperative and long-term outcomes of patients with clinicalⅠA (cⅠA) stage lung adenocarcinoma. Methods A retrospective analysis was done on the patients with cⅠA stage lung adenocarcinoma who received thoracoscopic radical resection admitted to the Affiliated Hospital of Qingdao University from January 2013 to August 2016. Propensity score matching was conducted to eliminate the biases. The recurrence-free survival was compared between the two groups after matching. Perioperative parameters and postoperative complications were also analyzed. Results A total of 725 patients were enrolled, including 252 males and 473 females, with a median age of 62.0 (31.0-69.0) years. There were 228 patients in the L-SND group and 497 patients in the SLND group. After matching, there were 211 patients in each group and no statistical difference in the incidence of postoperative complications (10.9% vs. 13.7%, P=0.374), identification of metastatic positive lymph nodes (12.3% vs. 9.0%, P=0.270), or recurrence-free survival (P=0.492) were found between two groups, whereas the operation time (163.9±39.4 min vs. 135.4±32.4 min, P＜0.001), intraoperative blood loss [100.0 (20.0-800.0) mL vs. 100.0 (10.0-400.0) mL, P＜0.001], intubation time [4.0 (1.0-18.0) d vs. 4.0 (1.0-9.0) d, P＜0.001] and hospital stay (12.3±3.3 d vs. 10.8±2.4 d, P=0.003) in the SLND group were found to be significantly higher or longer than those in the L-SND group. Conclusion L-SND has a similar efficiency to SLND in terms of postoperative complications, pathological lymph node metastasis, and recurrence-free survival, as well as significant advantages in reducing intraoperative blood loss, and shortening operation time, intubation time and length of hospital stay. Therefore, L-SND can be recommended to replace SLND as a method for lymph node resection in patients with cⅠA stage lung adenocarcinoma.

Citation： YI Tengfei, QIN Kun, SHAO Shengteng, LI Shuo, LIU Yuhong. Efficacy of systematic versus lobe-specific lymph node dissection in the treatment of clinicalⅠA stage lung adenocarcinoma: A propensity score matching study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1143-1150. doi: 10.7507/1007-4848.202111046 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
3.	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-27.
4.	Howington JA, Blum MG, Chang AC, et al. Treatment of stage Ⅰ and Ⅱ non-small cell lung cancer. Chest, 2013, 143(5): e278S-e313S.
5.	Gajra A, Newman N, Gamble GP, et al. Effect of number of lymph nodes sampled on outcome in patients with stage Ⅰ non-small-cell lung cancer. J Clin Oncol, 2003, 21(6): 1029-1034.
6.	Zhao Y, Mao Y, He J, et al. Lobe-specific lymph node dissection in clinical stageⅠA solid-dominant non-small-cell lung cancer: A propensity score matching study. Clin Lung Cancer, 2021, 22(2): e201-e210.
7.	Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: A large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg, 2010, 139(4): 1001-1006.
8.	Asamura H, Chansky K, Crowley J, et al. The international association for the study of lung cancer lung cancer staging project: Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(12): 1675-1684.
9.	Eberhardt WE, Mitchell A, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2015, 10(11): 1515-1522.
10.	Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.
11.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
12.	中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南 (2019版). 中华肿瘤杂志, 2020, 42(4): 257-287.
13.	Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
14.	Darling GE, Allen MS, Decker PA, et al. 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, 2011, 141(3): 662-670.
15.	Shapiro M, Kadakia S, Lim J, et al. Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer. Chest, 2013, 144(5): 1615-1621.
16.	Miyoshi S, Shien K, Toyooka S, et al. Validity of using lobe-specific regional lymph node stations to assist navigation during lymph node dissection in early stage non-small cell lung cancer patients. Surg Today, 2014, 44(11): 2028-2036.
17.	Shien K, Toyooka S, Soh J, et al. Clinicopathological characteristics and lymph node metastasis pathway of non-small-cell lung cancer located in the left lingular division. Interact Cardiovasc Thorac Surg, 2015, 20(6): 791-796.
18.	Yang, MZ, Hou X, Liang RB, et al. The incidence and distribution of mediastinal lymph node metastasis and its impact on survival in patients with non-small-cell lung cancers 3 cm or less: Data from 2292 cases. Eur J Cardiothorac Surg, 2019, 56(1): 159-166.
19.	Deng HY, Zhou J, Wang RL, et al. Lobe-specific lymph node dissection for clinical early-stage (cⅠA) peripheral non-small cell lung cancer patients: What and how? Ann Surg Oncol, 2020, 27(2): 472-480.
20.	Asamura H, Nakayama H, Kondo H, et al. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg, 1999, 117(6): 1102-1111.
21.	Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
22.	Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stageⅠlung cancer patients. Eur J Cardiothorac Surg, 2017, 51(4): 674-679.
23.	Wu Y, Han C, Gong L, et al. Metastatic patterns of mediastinal lymph nodes in small-size non-small cell lung cancer (T1b). Front Surg, 2020, 7: 580203.
24.	Fang L, Xu J, Ye B, et al. Is lobe specific lymph node dissection adequate for cN0-1 non-small cell lung cancer? J Cardiothorac Surg, 2020, 15(1): 46.
25.	Ding N, Mao Y, Gao S, et al. Predictors of lymph node metastasis and possible selective lymph node dissection in clinical stageⅠA non-small cell lung cancer. J Thorac Dis, 2018, 10(7): 4061-4068.
26.	Adachi H, Sakamaki K, Nishii T, et al. 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, 2017, 12(1): 85-93.
27.	Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stageⅠ andⅡ NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol, 2016, 11(9): 1529-1537.
28.	Wang Z, Qi Z, Cheng D, et al. Lobe-Specific node dissection can be a suitable alternative to systematic lymph node dissection in highly selective early-stage non-small-cell lung cancer patients: A meta-analysis. Ann Thorac Cardiovasc Surg, 2021, 27(3): 143-150.
29.	Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2013, 44(1): e59-e64.
30.	Cao J, Xu J, He Z, et al. Prognostic impact of lymphadenectomy on outcomes of sublobar resection for stageⅠA non-small cell lung cancer≤2 cm. J Thorac Cardiovasc Surg, 2018, 156(2): 796-805.
31.	Hishida T, Saji H, Watanabe SI, et al. A randomized Phase Ⅲ trial of lobe-specific vs. systematic nodal dissection for clinical stage Ⅰ-Ⅱ non-small cell lung cancer (JCOG1413). Jpn J Clin Oncol, 2018, 48(2): 190-194.
32.	Abughararah TZ, Jeong YH, Alabbood F, et al. Lobe-specific lymph node dissection in stageⅠA non-small-cell lung cancer: A retrospective cohort study. Eur J Cardiothorac Surg, 2021, 59(4): 783-790.
33.	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stageⅠA lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
34.	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
35.	Suzuki K, Watanabe S, Mizusawa J, et al. Predictors of non-neoplastic lesions in lung tumours showing ground-glass opacity on thin-section computed tomography based on a multi-institutional prospective study dagger. Interact Cardiovasc Thorac Surg, 2015, 21(2): 218-223.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
3. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-27.
4. Howington JA, Blum MG, Chang AC, et al. Treatment of stage Ⅰ and Ⅱ non-small cell lung cancer. Chest, 2013, 143(5): e278S-e313S.
5. Gajra A, Newman N, Gamble GP, et al. Effect of number of lymph nodes sampled on outcome in patients with stage Ⅰ non-small-cell lung cancer. J Clin Oncol, 2003, 21(6): 1029-1034.
6. Zhao Y, Mao Y, He J, et al. Lobe-specific lymph node dissection in clinical stageⅠA solid-dominant non-small-cell lung cancer: A propensity score matching study. Clin Lung Cancer, 2021, 22(2): e201-e210.
7. Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: A large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg, 2010, 139(4): 1001-1006.
8. Asamura H, Chansky K, Crowley J, et al. The international association for the study of lung cancer lung cancer staging project: Proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(12): 1675-1684.
9. Eberhardt WE, Mitchell A, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2015, 10(11): 1515-1522.
10. Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.
11. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
12. 中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南 (2019版). 中华肿瘤杂志, 2020, 42(4): 257-287.
13. Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
14. Darling GE, Allen MS, Decker PA, et al. 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, 2011, 141(3): 662-670.
15. Shapiro M, Kadakia S, Lim J, et al. Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer. Chest, 2013, 144(5): 1615-1621.
16. Miyoshi S, Shien K, Toyooka S, et al. Validity of using lobe-specific regional lymph node stations to assist navigation during lymph node dissection in early stage non-small cell lung cancer patients. Surg Today, 2014, 44(11): 2028-2036.
17. Shien K, Toyooka S, Soh J, et al. Clinicopathological characteristics and lymph node metastasis pathway of non-small-cell lung cancer located in the left lingular division. Interact Cardiovasc Thorac Surg, 2015, 20(6): 791-796.
18. Yang, MZ, Hou X, Liang RB, et al. The incidence and distribution of mediastinal lymph node metastasis and its impact on survival in patients with non-small-cell lung cancers 3 cm or less: Data from 2292 cases. Eur J Cardiothorac Surg, 2019, 56(1): 159-166.
19. Deng HY, Zhou J, Wang RL, et al. Lobe-specific lymph node dissection for clinical early-stage (cⅠA) peripheral non-small cell lung cancer patients: What and how? Ann Surg Oncol, 2020, 27(2): 472-480.
20. Asamura H, Nakayama H, Kondo H, et al. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg, 1999, 117(6): 1102-1111.
21. Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
22. Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stageⅠlung cancer patients. Eur J Cardiothorac Surg, 2017, 51(4): 674-679.
23. Wu Y, Han C, Gong L, et al. Metastatic patterns of mediastinal lymph nodes in small-size non-small cell lung cancer (T1b). Front Surg, 2020, 7: 580203.
24. Fang L, Xu J, Ye B, et al. Is lobe specific lymph node dissection adequate for cN0-1 non-small cell lung cancer? J Cardiothorac Surg, 2020, 15(1): 46.
25. Ding N, Mao Y, Gao S, et al. Predictors of lymph node metastasis and possible selective lymph node dissection in clinical stageⅠA non-small cell lung cancer. J Thorac Dis, 2018, 10(7): 4061-4068.
26. Adachi H, Sakamaki K, Nishii T, et al. 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, 2017, 12(1): 85-93.
27. Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stageⅠ andⅡ NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol, 2016, 11(9): 1529-1537.
28. Wang Z, Qi Z, Cheng D, et al. Lobe-Specific node dissection can be a suitable alternative to systematic lymph node dissection in highly selective early-stage non-small-cell lung cancer patients: A meta-analysis. Ann Thorac Cardiovasc Surg, 2021, 27(3): 143-150.
29. Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2013, 44(1): e59-e64.
30. Cao J, Xu J, He Z, et al. Prognostic impact of lymphadenectomy on outcomes of sublobar resection for stageⅠA non-small cell lung cancer≤2 cm. J Thorac Cardiovasc Surg, 2018, 156(2): 796-805.
31. Hishida T, Saji H, Watanabe SI, et al. A randomized Phase Ⅲ trial of lobe-specific vs. systematic nodal dissection for clinical stage Ⅰ-Ⅱ non-small cell lung cancer (JCOG1413). Jpn J Clin Oncol, 2018, 48(2): 190-194.
32. Abughararah TZ, Jeong YH, Alabbood F, et al. Lobe-specific lymph node dissection in stageⅠA non-small-cell lung cancer: A retrospective cohort study. Eur J Cardiothorac Surg, 2021, 59(4): 783-790.
33. Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stageⅠA lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
34. Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
35. Suzuki K, Watanabe S, Mizusawa J, et al. Predictors of non-neoplastic lesions in lung tumours showing ground-glass opacity on thin-section computed tomography based on a multi-institutional prospective study dagger. Interact Cardiovasc Thorac Surg, 2015, 21(2): 218-223.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of systematic versus lobe-specific lymph node dissection in the treatment of clinicalⅠA stage lung adenocarcinoma: A propensity score matching study in a single center

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