Risk factors associated with lymph node metastasis in lung adenocarcinoma with diameter≤3 cm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIN Shaowei ^1,2,3 , XIN Xiangbing ¹ , ZHAO Yabo ¹ , WEN Miaomiao ¹ , JIANG Suxin ² ,  XIONG Yanlu ^1,4

1. Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, P. R. China;
2. Department of Thoracic Surgery, Air Force Medical Center, Air Force Medical University, Beijing, 100142, P. R. China;
3. Department of Thoracic Surgery, 962 Hospital of Joint Logistics Support Force, Harbin, 150000, P. R. China;
4. Innovation Center for Advanced Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, P. R. China;

Corresponding author：

XIONG Yanlu, Email: xiong21@fmmu.edu.cn

Keywords：

Lung adenocarcinoma; lymph node metastasis; pathological subtype; micropapillary component

DOI：

10.7507/1007-4848.202402048

Video：

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Objective To explore the correlation between lymph node metastasis and clinicopathological features of lung adenocarcinoma with diameter≤3 cm. Methods The clinicopathologic data of the patients with lung adenocarcinoma≤3 cm in diameter were retrospectively analyzed. The relationship between lymph node metastasis and age, gender, smoking history, pathological subtype, tumor location, tumor diameter, pleural invasion, vascular invasion and other factors was analyzed. The risk factors of lymph node metastasis were analyzed by univariate and multivariate logistic regression. Results Finally 1 718 patients were collected, including 697 males and 1 021 females with an average age of 58.89±9.85 years. The total lymph node metastasis rate was 12.9%, among whom 452 patients of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) did not have lymph node metastasis, and the lymph node metastasis rate of invasive lung adenocarcinoma was 17.5%. Multivariate analysis showed that tumor diameter, micropapillary subtype, solid subtype, micropapillary component, solid component, vascular invasion and pleural invasion were independent risk factors for lymph node metastasis of invasive lung adenocarcinoma with diameter≤3 cm (P<0.05). While age, lepidic subtype and lepidic component were independent protective factors for lymph node metastasis (P<0.05). Conclusion Clinicopathological features can help predict lymph node metastasis of lung adenocarcinoma with diameter≤3 cm.

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2.	Succony L, Rassl DM, Barker AP, et al. Adenocarcinoma spectrum lesions of the lung: Detection, pathology and treatment strategies. Cancer Treat Rev, 2021, 99: 102237.
3.	Asamura H, Nishimura KK, Giroux DJ, et al. IASLC lung cancer staging project: The new database to inform revisions in the ninth edition of the TNM classification of lung cancer. J Thorac Oncol, 2023, 18(5): 564-575.
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6.	李刚, 罗俊, 邓汉宇, 等. 非小细胞肺癌术中淋巴结清扫方式的研究进展. 中国胸心血管外科临床杂志, 2019, 26(3): 282-289.
7.	Matsushima K, Sonoda D, Mitsui A, et al. Factors associated with lymph node metastasis upstage after resection for patients with micropapillary lung adenocarcinoma. Thorac Cancer, 2022, 13(1): 48-53.
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9.	张杰石, 秦应之, 黄诚, 等. 侵袭性肺腺癌微乳头亚型与淋巴结转移的相关性分析. 临床外科杂志, 2017, 25(7): 498-499.
10.	杨彦辉, 李季, 王毅, 等. 直径≤3 cm肺腺癌胸腔镜术后淋巴结转移的预测模型构建. 中国胸心血管外科临床杂志, 202, 31(1): 71-77.
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13.	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): 615-622.
14.	Aokage K, Miyoshi T, Ishii G, et al. Influence of ground glass opacity and the corresponding pathological findings on survival in patients with clinical stageⅠnon-small cell lung cancer. J Thorac Oncol, 2018, 13(4): 533-542.
15.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301.
16.	Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): A multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
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18.	Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ⅠA non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
19.	Zhang W, Mu G, Huang J, et al. Lymph node metastasis and its risk factors in T1 lung adenocarcinoma. Thorac Cancer, 2023, 14(30): 2993-3000.
20.	Liu C, Wang LC, Chen HS, et al. Outcomes of patients with different lepidic percentage and tumor size of stageⅠlung adenocarcinoma. Thorac Cancer, 2022, 13(14): 2005-2013.
21.	于航, 张永奎, 竺王玉, 等. 浸润性肺腺癌淋巴结转移情况及相关危险因素分析. 浙江医学, 2022, 44(4): 388-391.
22.	Sun W, Su H, Liu J, et al. Impact of histological components on selecting limited lymphadenectomy for lung adenocarcinoma≤ 2 cm. Lung Cancer, 2020, 150: 36-43.
23.	Wang Z, Wu Y, Wang L, et al. Predicting occult lymph node metastasis by nomogram in patients with lung adenocarcinoma≤2 cm. Future Oncol, 2021, 17(16): 2005-2013.
24.	何慧, 张永奎. 1 085例手术切除浸润性肺腺癌淋巴结转移的相关因素分析及诺模图模型的建立. 中国肿瘤临床, 2021, 48(4): 169-173.
25.	孙嘉阳, 鲁志刚, 郭占林, 等. 老年临床N0期非小细胞肺癌患者术后N1-2期淋巴结转移的危险因素分析. 中华实用诊断与治疗杂志, 2023, 37(2): 129-132.
26.	马杰, 马冬春, 陈启斌, 等. 直径≤3 cm浸润性肺腺癌脉管侵犯的危险因素分析. 实用癌症杂志, 2021, 36(1): 135-138.
27.	Shigenobu T, Takahashi Y, Masugi Y, et al. Micropapillary predominance is a risk factor for brain metastasis in resected lung adenocarcinoma. Clin Lung Cancer, 2021, 22(6): e820-e828.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Succony L, Rassl DM, Barker AP, et al. Adenocarcinoma spectrum lesions of the lung: Detection, pathology and treatment strategies. Cancer Treat Rev, 2021, 99: 102237.
3. Asamura H, Nishimura KK, Giroux DJ, et al. IASLC lung cancer staging project: The new database to inform revisions in the ninth edition of the TNM classification of lung cancer. J Thorac Oncol, 2023, 18(5): 564-575.
4. Ito H, Date H, Shintani Y, et al. The prognostic impact of lung adenocarcinoma predominance classification relating to pathological factors in lobectomy, the Japanese Joint Committee of Lung Cancer Registry Database in 2010. BMC Cancer, 2022, 22(1): 875.
5. 吴思凯, 王子民, 孙铧, 等. CALGB140503研究: 亚肺叶切除是早期周围型肺癌的标准术式? 中国胸心血管外科临床杂志, 2023, 30(8): 1097-1101.
6. 李刚, 罗俊, 邓汉宇, 等. 非小细胞肺癌术中淋巴结清扫方式的研究进展. 中国胸心血管外科临床杂志, 2019, 26(3): 282-289.
7. Matsushima K, Sonoda D, Mitsui A, et al. Factors associated with lymph node metastasis upstage after resection for patients with micropapillary lung adenocarcinoma. Thorac Cancer, 2022, 13(1): 48-53.
8. 尹纯同, 张春岩, 李华伟, 等. T1期肺腺癌患者淋巴结转移相关因素分析. 中国胸心血管外科临床杂志. 2018;25(09): 755-761.
9. 张杰石, 秦应之, 黄诚, 等. 侵袭性肺腺癌微乳头亚型与淋巴结转移的相关性分析. 临床外科杂志, 2017, 25(7): 498-499.
10. 杨彦辉, 李季, 王毅, 等. 直径≤3 cm肺腺癌胸腔镜术后淋巴结转移的预测模型构建. 中国胸心血管外科临床杂志, 202, 31(1): 71-77.
11. 林耀彬, 林勇斌, 赵泽锐, 等. 《人工智能在肺结节诊治中的应用专家共识(2022年版)》解读. 中国胸心血管外科临床杂志, 2023, 30(5): 665-671.
12. Cardillo G, Petersen RH, Ricciardi S, et al. European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg, 2023, 64(4): ezad222.
13. 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): 615-622.
14. Aokage K, Miyoshi T, Ishii G, et al. Influence of ground glass opacity and the corresponding pathological findings on survival in patients with clinical stageⅠnon-small cell lung cancer. J Thorac Oncol, 2018, 13(4): 533-542.
15. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301.
16. Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): A multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
17. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
18. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ⅠA non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
19. Zhang W, Mu G, Huang J, et al. Lymph node metastasis and its risk factors in T1 lung adenocarcinoma. Thorac Cancer, 2023, 14(30): 2993-3000.
20. Liu C, Wang LC, Chen HS, et al. Outcomes of patients with different lepidic percentage and tumor size of stageⅠlung adenocarcinoma. Thorac Cancer, 2022, 13(14): 2005-2013.
21. 于航, 张永奎, 竺王玉, 等. 浸润性肺腺癌淋巴结转移情况及相关危险因素分析. 浙江医学, 2022, 44(4): 388-391.
22. Sun W, Su H, Liu J, et al. Impact of histological components on selecting limited lymphadenectomy for lung adenocarcinoma≤ 2 cm. Lung Cancer, 2020, 150: 36-43.
23. Wang Z, Wu Y, Wang L, et al. Predicting occult lymph node metastasis by nomogram in patients with lung adenocarcinoma≤2 cm. Future Oncol, 2021, 17(16): 2005-2013.
24. 何慧, 张永奎. 1 085例手术切除浸润性肺腺癌淋巴结转移的相关因素分析及诺模图模型的建立. 中国肿瘤临床, 2021, 48(4): 169-173.
25. 孙嘉阳, 鲁志刚, 郭占林, 等. 老年临床N0期非小细胞肺癌患者术后N1-2期淋巴结转移的危险因素分析. 中华实用诊断与治疗杂志, 2023, 37(2): 129-132.
26. 马杰, 马冬春, 陈启斌, 等. 直径≤3 cm浸润性肺腺癌脉管侵犯的危险因素分析. 实用癌症杂志, 2021, 36(1): 135-138.
27. Shigenobu T, Takahashi Y, Masugi Y, et al. Micropapillary predominance is a risk factor for brain metastasis in resected lung adenocarcinoma. Clin Lung Cancer, 2021, 22(6): e820-e828.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesRisk factors associated with lymph node metastasis in lung adenocarcinoma with diameter≤3 cm

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