Status and Risk Factors Analysis on 4L Lymphatic Metastasis in Lung Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONGShang-qi , LIUCheng-wu , GUOCheng-lin , LIChuan , PUQiang , MALin , MEIJian-dong , LIAOHu ,  LIULun-xu

Department of Toracic Surgery, West China Hospital, Sichuan University, Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Terapy of Lung Cancer, Chengdu 610041, P. R. China;

Corresponding author：

LIULun-xu, Email: lunxu_liu@aliyun.com

Keywords：

Lung carcinoma; 4L lymph node; Lymphatic metastasis; Lymph node dissection

DOI：

10.7507/1007-4848.20150275

Video：

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Objective To observe the outcome of left lung cancer underwent surgical treatment and to analysis the relative risk factors for 4L lymphatic metastasis. Methods We retrospectively analyzed the clinical data of 643 lung cancer patients who had underwent mediastinal lymph node dissection intraoperatively in our hospital between January 2011 and December 2013. There were 430 males and 213 females with a mean age of 60.2±9.6 years(range 22 to 83 years), 260 patients had their 4L lymph node dissected, while other 383 patients did not. Results Among 260 patients with 4L lymph node dissected, 44(16.9%) were found 4L lymph node metastasis pathologically. And the results indicated that station 5 lymph node metastasis(P=0.000, OR=12.108 with 95%CI 4.564 to 32.122), station 7 lymph node metastasis(P=0.000, OR=8.496 with 95%CI 2.594 to 27.827), station 8 lymph node metastasis(P=0.029, OR=24.915 with 95%CI 1.395 to 444.948), station 10 lymph node metastasis(P=0.014, OR=3.983, 95%CI 1.321 to 12.009) were independently associated with high risk for 4L lymph node metastasis. Conclusion 4L lymphadenectomy should be performed for left invasive lung cancer regularly, especially for patients with hilar lymph node and other mediastinal lymph node metastasis.

Citation： SONGShang-qi, LIUCheng-wu, GUOCheng-lin, LIChuan, PUQiang, MALin, MEIJian-dong, LIAOHu, LIULun-xu. Status and Risk Factors Analysis on 4L Lymphatic Metastasis in Lung Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(12): 1100-1103. doi: 10.7507/1007-4848.20150275 Copy

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2.	Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1):268-275.
3.	周文,张鹏. 肺癌患者手术治疗中淋巴结清扫的原则与方式. 中国肺癌杂志, 2009, 12(7):805-810.
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5.	吴一龙, 王思愚, 黄植蕃.Ⅰ~ⅢA期非小细胞肺癌淋巴结清扫范围的前瞻性研究. 中华肿瘤杂志, 2001, 23(1):43-45.
6.	Hirono T, Yamato Y, Souma T, et al. How extensive should lymph node dissection be done for the surgery of the left lung cancer. Kyobu Geka, 1994, 47(1):20-23.
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8.	Vansteenkiste JF, De Leyn PR, Deneffe GJ, et al. Clinical prognostic factors in surgically treated stage IIIA-N2 non-small cell lung cancer:analysis of the literature. Lung Cancer, 1998, 19(1):3-13.
9.	Rami-Porta R, Wittekind C, Goldstraw P, et al. Complete resection in lung cancer surgery:proposed definition. Lung Cancer, 2005, 49(1):25-33.
10.	Varlotto JM, Recht A, Nikolov M, et al. Extent of lymphadenectomy and outcome for patients with stage I non-small cell lung cancer. Cancer, 2009, 115(4):851-858.
11.	Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1):268-275.
12.	Witte B, Hurtgen M. Video-assisted mediastinoscopic lymphadenectomy. Multimed Man Cardiothorac Surg, 2007, 2007(1018):mmcts. 2006. 002576. doi:10.1510/mmcts.2006.002576.
13.	Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15(1):38.
14.	Mauro A, Jacomo A. Anatomy of the Human Lymphatic System. Stanley P. L. Leong, Chief editor. Cancer Metastasis and the Lymphovascular System:Basis for Rational Therapy. San Francisco:Springer, 2007. 55-77.
15.	Okada M, Tsubota N, Yoshimura M, et al. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas:role of subcarinal nodes in selective dissection. Thorac Cardiovasc Surg, 1998, 116(6):949-953.
16.	Aokage K, Yoshida J, 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.	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.
18.	Hirono T, Yamato Y, Souma T, et al. How extensive should lymph node dissection be done for the surgery of the left lung cancer? Kyobu Geka, 1994, 47(1):20-23.
19.	Leschber G, Holinka G, Linder A, et al. Video-assisted mediastinoscopic lymphadenectomy (VAMLA)——a method for systematic mediastinal lymphnode dissection. Eur J Cardiothorac Surg, 2003, 24(2):192-195.

1. Friedel G, Linder A, Pfeiffer S, et al. Radical lung surgery interventions with special reference to lymphadenectomy. Langenbecks Arch Chir Suppl Kongressbd, 1996, 113:785-789.
2. Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1):268-275.
3. 周文,张鹏. 肺癌患者手术治疗中淋巴结清扫的原则与方式. 中国肺癌杂志, 2009, 12(7):805-810.
4. 支修益, 石远凯,于金明. 中国原发性肺癌诊疗规范(2015年版). 中华肿瘤杂志, 2015, 37(1):67-78.
5. 吴一龙, 王思愚, 黄植蕃.Ⅰ~ⅢA期非小细胞肺癌淋巴结清扫范围的前瞻性研究. 中华肿瘤杂志, 2001, 23(1):43-45.
6. Hirono T, Yamato Y, Souma T, et al. How extensive should lymph node dissection be done for the surgery of the left lung cancer. Kyobu Geka, 1994, 47(1):20-23.
7. 叶波, 杨龙海, 刘向阳, 等. 最新国际肺癌TNM分期标准(第7版)修订稿解读. 中国医刊, 2008, 43(1):21-23.
8. Vansteenkiste JF, De Leyn PR, Deneffe GJ, et al. Clinical prognostic factors in surgically treated stage IIIA-N2 non-small cell lung cancer:analysis of the literature. Lung Cancer, 1998, 19(1):3-13.
9. Rami-Porta R, Wittekind C, Goldstraw P, et al. Complete resection in lung cancer surgery:proposed definition. Lung Cancer, 2005, 49(1):25-33.
10. Varlotto JM, Recht A, Nikolov M, et al. Extent of lymphadenectomy and outcome for patients with stage I non-small cell lung cancer. Cancer, 2009, 115(4):851-858.
11. Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1):268-275.
12. Witte B, Hurtgen M. Video-assisted mediastinoscopic lymphadenectomy. Multimed Man Cardiothorac Surg, 2007, 2007(1018):mmcts. 2006. 002576. doi:10.1510/mmcts.2006.002576.
13. Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15(1):38.
14. Mauro A, Jacomo A. Anatomy of the Human Lymphatic System. Stanley P. L. Leong, Chief editor. Cancer Metastasis and the Lymphovascular System:Basis for Rational Therapy. San Francisco:Springer, 2007. 55-77.
15. Okada M, Tsubota N, Yoshimura M, et al. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas:role of subcarinal nodes in selective dissection. Thorac Cardiovasc Surg, 1998, 116(6):949-953.
16. Aokage K, Yoshida J, 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. 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.
18. Hirono T, Yamato Y, Souma T, et al. How extensive should lymph node dissection be done for the surgery of the left lung cancer? Kyobu Geka, 1994, 47(1):20-23.
19. Leschber G, Holinka G, Linder A, et al. Video-assisted mediastinoscopic lymphadenectomy (VAMLA)——a method for systematic mediastinal lymphnode dissection. Eur J Cardiothorac Surg, 2003, 24(2):192-195.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Status and Risk Factors Analysis on 4L Lymphatic Metastasis in Lung Cancer

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