Relationship between Subcarinal Lymph Node Metastasis and Clinicopathological Characteristics of Non-small Cell Lung Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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Department of 　Thoracic Surgery of Affiliated Cancer Hospital， Zhengzhou University， Zhengzhou 450008， P. R. China;

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Keywords：

Non-small cell lung cancer; 　Subcarinal lymph node metastasis; 　Lymph node dissection

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Abstract： Objective To analyze the modes and rules of subcarinal lymph node metastasis in non-small cell lung cancer patients， and explore appropriate surgical dissection strategy of subcarinal lymph nodes for patients with non-small cell lung cancer. Methods The clinical data of 608 patients with non-small cell lung cancer who underwent lung resection　 and systematic lymph node dissection in Henan Cancer Hospital from September 2002 to October 2011 were analyzed　 retrospectively. There were 388 males and 220 females with an average age of 62.3 （45-78） years. There were 122 patients with left upper lobe tumor， 119 patients with left lower lobe tumor， 158 patients with right upper lobe tumor， 40 patients with right middle lobe tumor and 169 patients with right lower lobe tumor. Subcarinal lymph node metastasis was observed in 118 patients （19.4%）. There were 244 patients with squamous carcinoma， 285 patients with adenocarcinoma and 79　 patients with other types of carcinoma. The relationship of subcarinal lymph node metastasis with tumor location， pathological types and clinicopathological characteristics were analyzed. Results There was statistical difference in subcarinal　 lymph node metastasis rate among different tumor locations （P=0.000）. Subcarinal lymph node metastasis rate was the highest ［45.8% （54/118）］ in patients with right lower lobe tumor. For patients with different pathological types， subcarinal lymph node metastasis rate was the highest ［55.9% （66/118）］ in patients with adenocarcinoma， and then squamous carcinoma （P=0.034）. Subcarinal lymph node metastasis rate increased with the increase in T staging， and patients with tumors　 located in the middle or lower lobe of the left or right lung had a significantly higher subcarinal lymph node metastasis rate than patients with upper lobe tumor. Conclusion Subcarinal lymph node metastasis rate are lower in patients with left or right upper lobe tumor， patients with squamous carcinoma whose clinical T staging is within cT 1 .

Citation： QU Ge,CHEN Xintao,WANG Xiaolong,QIN Jianjun.. Relationship between Subcarinal Lymph Node Metastasis and Clinicopathological Characteristics of Non-small Cell Lung Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(1): 70-73. doi: Copy

1.	Sugi K， Nawata K， Fujita N， et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg， 1998， 22 （3）：290-294.
2.	Wu YL， Huang ZF， Wang SY， et al. A randomized trial of systematic　 nodal dissection in resectable non-small cell lung cancer. Lung Cancer， 2002， 36 （1）：1-6.
3.	Izbicki JR， Thetter O， Habekost M， et al. Radical systematic　 mediastinal lymphadenectomy in non-small cell lung cancer：a randomized controlled trial. Br J Surg， 1994， 81 （2）：229-235.
4.	Wright G， Manser RL， Byrnes G， et al. Surgery for non-small cell lung cancer：systematic review and meta-analysis of randomised　 controlledtrials. Thorax， 2006， 61 （7）：597-603.
5.	Martini N， Flehinger BJ， Zaman MB， et al. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node　 metastases. Ann Surg， 1983， 198 （3）：386-397.
6.	Naruke T， Goya T， Tsuchiya R， et al. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node　 metastasis. Ann Thorac Surg， 1988， 46 （6）：603-610.
7.	Naruke T， Goya T， Tsuchiya R， et al. Prognosis and survival in　 resected lung carcinoma based on the new international staging　 system. J Thorac Cardiovasc Surg， 1988， 96 （3）：440-447.
8.	Martini N， Flehinger BJ， Zaman MB， et al. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node　 metastases. Ann Surg， 1983， 198 （3）：386-397.
9.	Ginsberg RJ， Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg， 1995， 60 （3）：615-623.
10.	Lewis RJ， Caccavale RJ， Sisler GE， et al. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg， 1992， 104 （6）：1679-1685.
11.	Roviaro G， Rebuffat C， Varoli F， et al. Videoendoscopic pulmonary lobectomy for Cancer. Surg Laparosc Endosc， 1992， 2 （3）：244-247.
12.	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.
13.	刘伦旭. 开胸手术将逐渐“升级”为胸腔镜微创手术的补充. 中国胸心血管外科临床杂志， 2012， 19 （2）：109-112.
14.	初向阳，薛志强，刘毅，等. 单操作孔电视胸腔镜肺叶切除术治疗早期肺癌的临床研究. 中国胸心血管外科临床杂志， 2012， 19 （2）：113-115．.
15.	Flores RM， Alam N. Video-assisted thoracic surgery lobectomy （VATS）， open thoracotomy， and the robot for lung cancer. Ann Thorac Surg， 2008， 85 （2）：S710-S715.
16.	Aokage K， Junji Y， Ishii G， et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients：is selective lymph node　 dissection valid ? Lung Cancer， 2010， 70 （2）：163-167.
17.	Watanabe Y， Shimizu J， Tsubota M， et al．Mediastinal spread of metastatic lymph nodes in bronchogenic carcinoma. Mediastinal nodal metastases in lung cancer. Chest， 1990， 97 （5）：1059-1065.
18.	Ettinger DS， Akerley W， Borghaei H， et al. NCCN Clinical Practice　 Guidelines in Oncology：Non-small Cell Lung Cancer. J Natl Compr Canc Netw， 2011， 1 （1）：43-44.
19.	Yoshimasa M， Iwata H， Shirahashi K， et al. The importance of intraoperative fluid balance for the prevention of postoperative acute exacerbation of idiopathic pulmonary fibrosis after pulmonary resection　 for primary lung cancer. Eur J Cardiothorac Surg， 2012， 41 （6）：e161-e165.
20.	Okada M， Tsubota N， Yoshimura M， et al． Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas：role of subcarinal nodes in selective dissection. J Thorac Cardiovasc Surg， 1998， 116 （6）：949-953.
21.	Tsubota N， Yoshimura M. Skip metastasis and hidden N2 disease in lung cancer：how successful is mediastinal dissection ? Surg Today， 1996， 26 （3）：169-172.
22.	Allen MS， Darling GE， Pechet TT， et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer：initial results of the randomized， prospective ACOSOG Z0030 trial. Ann Thorac Surg， 2006， 81 （3）：1013-1019.
23.	Satoh Y， Okumura S， Nakagawa K， et al. Postoperative ischemic change in bronchial stumps after primary lung cancer resection. Eur J Cardiothorac Surg， 2006， 30 （1）：172-176.
24.	Alam N， Park BJ， Wilton A， et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg， 2007， 84 （4）：1085-1091.
25.	Patz EF Jr， Erasmus JJ， Mcadams HP， et al. Lung cancer staging and management：comparison of contrast-enhanced and nonenhanced helical CT of the thorax. Radiology， 1999， 212 （1）：56-60.
26.	Hasegawa I， Boiselle PM， Kuwabara K， et al. Mediastinal lymph nodes in patients with non-small cell lung cancer：preliminary　 experience with diffusion-weighted Mr imaging. J Thorac Imaging， 2008， 23 （3）：157-161.
27.	Maziak DE， Darling GE， Inculet RI， et al. Positron emission tomography in staging early lung cancer：a randomized trial. Ann Intern Med， 2009， 151 （4）：221-228.
28.	Hwangbo B， Kim SK， Lee HS， et al. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated　 PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest， 2009， 135 （5）：1280-1287.
29.	Fukui T， Katayama T， Ito S， et al. Clinicopathological features of small-sized non-small cell lung cancer with mediastinal lymph node metastasis. Lung Cancer， 2009， 66 （3）：309-313.

1. Sugi K， Nawata K， Fujita N， et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg， 1998， 22 （3）：290-294.
2. Wu YL， Huang ZF， Wang SY， et al. A randomized trial of systematic　 nodal dissection in resectable non-small cell lung cancer. Lung Cancer， 2002， 36 （1）：1-6.
3. Izbicki JR， Thetter O， Habekost M， et al. Radical systematic　 mediastinal lymphadenectomy in non-small cell lung cancer：a randomized controlled trial. Br J Surg， 1994， 81 （2）：229-235.
4. Wright G， Manser RL， Byrnes G， et al. Surgery for non-small cell lung cancer：systematic review and meta-analysis of randomised　 controlledtrials. Thorax， 2006， 61 （7）：597-603.
5. Martini N， Flehinger BJ， Zaman MB， et al. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node　 metastases. Ann Surg， 1983， 198 （3）：386-397.
6. Naruke T， Goya T， Tsuchiya R， et al. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node　 metastasis. Ann Thorac Surg， 1988， 46 （6）：603-610.
7. Naruke T， Goya T， Tsuchiya R， et al. Prognosis and survival in　 resected lung carcinoma based on the new international staging　 system. J Thorac Cardiovasc Surg， 1988， 96 （3）：440-447.
8. Martini N， Flehinger BJ， Zaman MB， et al. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node　 metastases. Ann Surg， 1983， 198 （3）：386-397.
9. Ginsberg RJ， Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg， 1995， 60 （3）：615-623.
10. Lewis RJ， Caccavale RJ， Sisler GE， et al. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg， 1992， 104 （6）：1679-1685.
11. Roviaro G， Rebuffat C， Varoli F， et al. Videoendoscopic pulmonary lobectomy for Cancer. Surg Laparosc Endosc， 1992， 2 （3）：244-247.
12. 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.
13. 刘伦旭. 开胸手术将逐渐“升级”为胸腔镜微创手术的补充. 中国胸心血管外科临床杂志， 2012， 19 （2）：109-112.
14. 初向阳，薛志强，刘毅，等. 单操作孔电视胸腔镜肺叶切除术治疗早期肺癌的临床研究. 中国胸心血管外科临床杂志， 2012， 19 （2）：113-115．.
15. Flores RM， Alam N. Video-assisted thoracic surgery lobectomy （VATS）， open thoracotomy， and the robot for lung cancer. Ann Thorac Surg， 2008， 85 （2）：S710-S715.
16. Aokage K， Junji Y， Ishii G， et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients：is selective lymph node　 dissection valid ? Lung Cancer， 2010， 70 （2）：163-167.
17. Watanabe Y， Shimizu J， Tsubota M， et al．Mediastinal spread of metastatic lymph nodes in bronchogenic carcinoma. Mediastinal nodal metastases in lung cancer. Chest， 1990， 97 （5）：1059-1065.
18. Ettinger DS， Akerley W， Borghaei H， et al. NCCN Clinical Practice　 Guidelines in Oncology：Non-small Cell Lung Cancer. J Natl Compr Canc Netw， 2011， 1 （1）：43-44.
19. Yoshimasa M， Iwata H， Shirahashi K， et al. The importance of intraoperative fluid balance for the prevention of postoperative acute exacerbation of idiopathic pulmonary fibrosis after pulmonary resection　 for primary lung cancer. Eur J Cardiothorac Surg， 2012， 41 （6）：e161-e165.
20. Okada M， Tsubota N， Yoshimura M， et al． Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas：role of subcarinal nodes in selective dissection. J Thorac Cardiovasc Surg， 1998， 116 （6）：949-953.
21. Tsubota N， Yoshimura M. Skip metastasis and hidden N2 disease in lung cancer：how successful is mediastinal dissection ? Surg Today， 1996， 26 （3）：169-172.
22. Allen MS， Darling GE， Pechet TT， et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer：initial results of the randomized， prospective ACOSOG Z0030 trial. Ann Thorac Surg， 2006， 81 （3）：1013-1019.
23. Satoh Y， Okumura S， Nakagawa K， et al. Postoperative ischemic change in bronchial stumps after primary lung cancer resection. Eur J Cardiothorac Surg， 2006， 30 （1）：172-176.
24. Alam N， Park BJ， Wilton A， et al. Incidence and risk factors for lung injury after lung cancer resection. Ann Thorac Surg， 2007， 84 （4）：1085-1091.
25. Patz EF Jr， Erasmus JJ， Mcadams HP， et al. Lung cancer staging and management：comparison of contrast-enhanced and nonenhanced helical CT of the thorax. Radiology， 1999， 212 （1）：56-60.
26. Hasegawa I， Boiselle PM， Kuwabara K， et al. Mediastinal lymph nodes in patients with non-small cell lung cancer：preliminary　 experience with diffusion-weighted Mr imaging. J Thorac Imaging， 2008， 23 （3）：157-161.
27. Maziak DE， Darling GE， Inculet RI， et al. Positron emission tomography in staging early lung cancer：a randomized trial. Ann Intern Med， 2009， 151 （4）：221-228.
28. Hwangbo B， Kim SK， Lee HS， et al. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated　 PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest， 2009， 135 （5）：1280-1287.
29. Fukui T， Katayama T， Ito S， et al. Clinicopathological features of small-sized non-small cell lung cancer with mediastinal lymph node metastasis. Lung Cancer， 2009， 66 （3）：309-313.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Relationship between Subcarinal Lymph Node Metastasis and Clinicopathological Characteristics of Non-small Cell Lung Cancer

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