Clinical Significance of Lymph Node inside Lung Dissection of Non-small Cell Lung Cancer in Stage T<sub>1</sub>_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENJian ,  XUNing , LIXin-yan

Department of Thoracic Surgery of Dalian Central Hospital, Dalian 116033 Liaoning, P.R.China;

Corresponding author：

XUNing, Email: pierrexu@163.com

Keywords：

Stage T₁ primary peripheral non-small cell lung cancer; Lymph node metastasis; Neoplasm staging

DOI：

10.7507/1007-4848.20160079

Video：

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Objective To investigate the primary peripheral non-small cell lung cancer (NSCLC) in stage T₁ of TNM (UICC2011) (the tumor size≤3 cm) and to find out the lymphadenectomy way which will benefit patients most. Methods We retrospectively analyzed the clinical data of 60 patients with primary peripheral NSCLC in our hospital between November 2014 and May 2015. There were 26 males and 34 females at age of 34-76 (57.91±7.75) years. The lymph nodes dissection and metastasis were recorded. Results The total number of intrathoracic lymph nodes dissection is 1 208,with an average of 20.1, including 33 metastasis lymph nodes. The metastasis rate was 2.73%. A total of 51 patients were not found the mediastinum and hilum metastasis lymph node through the routine pathological detection method，while metastasis lymph node in section 12 and (or) 13 and (or) 14 group were found in 3 patients in our trial. The detection rate was 5.89%. For stage T₁ primary peripheral NSCLC, with increasing tumor size, lymph node metastasis rate was gradually increased. The patients with solid lesions were more likely to have lymph node metastasis than those with non-solid lesions (pure ground-glass nodules or mixed ground-glass nodules) which generally did not find lymph node metastasis. Conclusion The lymph node metastasis rate in stage T₁ primary peripheral NSCLC is related to the tumor size, nature, histological type, local pleural stretch in imaging. The dissection of lung lymph node (12+13+14 groups)may be able to find simple intrapulmonary lymph nodes metastasis. It is important to the selection of delineated staging and treatment program in stage T₁ primary peripheral NSCLC.

Citation： CHENJian, XUNing, LIXin-yan. Clinical Significance of Lymph Node inside Lung Dissection of Non-small Cell Lung Cancer in Stage T₁. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 341-345. doi: 10.7507/1007-4848.20160079 Copy

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14.	章智荣, 毛有生, 赫捷, 等. 临床I期非小细胞肺癌淋巴结转移规律和清扫方式的探讨. 中华肿瘤杂志, 2014, 36(6): 536-540.
15.	Takizawa T, Terashima M, Koike T, et al. Lymph node metastasis in small peripheral adenocarcinoma of the lung. J Thorac Cardiovasc Surg, 1998, 116(2): 276-280.
16.	Suzuki K, Nagai K, Yoshida J, et al. Clinical predictors of N2 disease in the setting of a negative computed tomographic scan in patients with lung cancer. J Thorac Cardiovasc Surg, 1999, 117(3): 593-598.
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18.	Misthos P, Sepsas E, Athanassiadi K, et al. Skip metastases:analysis of their clinical significance and prognosis in the IIIA stage of non-small cell lung cancer. Eur J Cardiothorac Surg, 2004, 25(4): 502-508.
19.	Prenzel KL, Monig SP, Sinning JM, et al. Role of skip metastasis to mediastinal lymph nodes in non-small cell lung cancers. J Surg Oncol, 2003, 82(4): 256-260.
20.	蒋浩, 陈军, 张银文. T₁肺癌淋巴结转移规律的临床研究. 中国临床医生, 2014, 42(6): 54-55.
21.	谢远才, 李运, 王俊, 等. 直径≤3cm的周围型非小细胞肺癌纵隔淋巴结转移规律的初步研究. 中国微创外科杂志, 2010, 10(7): 577-580.

1. Jemal A, Siegel R, Xu J, et al. Cancer statistics. CA Cancer J Clin, 2010, 60(5): 277-300.
2. Chute JP, Chen T, Feigal E, et al. Twenty years of phase III trials for patients with extensive-stage small-cell lung cancer. Perceptible progress. J Clin Oncol, 1999, 17(6): 1794-1801.
3. 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): 67-68.
4. Kaneko M, Kusumoto M, Kobayashi T, et al. Computed tomography screening for lung carcinoma in Japan. Cancer, 2000, 89(11 Suppl): 2484-2488.
5. Verhagen AF, Bulten J, Shirango H, et al. The clinical value of lymphatic micrometastases in patients with non-small cell lung cancer. J Torac Oncol, 2010, 5(8): 1201-1205.
6. Darling GE, Allen MS, Decker PA, et al. Number of lymph nodes harvested from a mediastinally mphadenectomy: Results of the randomized, prospective ACOSOG Z0030 Trial. Chest, 2010, 139(5): 1124-1129.
7. 孙即昆, 主编. 肺外科学. 北京: 人民卫生出版社, 1987. 24-25.
8. Takahashi K, Stanford W, VanBeek E, et al. Mediastinal lymphatic drainage from pulmonary lobe based on CT observations of histoplasmosis: implications for minimal N2 disease of non-small-cell lung cancer. Radiat Med, 2007, 25(8): 393-401.
9. Naruke T, Suemasu K, Ishikawa S. Lymphnode mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg, 1978, 76(6): 832-839.
10. Goldstraw P, Crowley J, Chansky K, et al. The ISALC Lung Cancer staging project:proposal for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(1): 706-714.
11. Henschke CI, Yankelevitz DF, Libby DM, et al. Survival of patients with stage I lung cancer detected on CT screen. N Engl J Med, 2006, 355(17): 1763-1771.
12. Kim EA, Johkoh T, Lee KS, et al. Quantification of ground-glass opacity on high-resolution CT of small peripheral adenocarcinoma of the lung: pathologic and prognostic implications. AJR Am J Roentgenol, 2001, 177(6): 1417-1422.
13. Kodama K, Higashiyama M, Yokouchi H, et al. Prognostic value of groundglass opacity found in small lung adenocarcinoma on high-resolution CT scanning. Lung Cancer, 2001, 33(1): 17-25.
14. 章智荣, 毛有生, 赫捷, 等. 临床I期非小细胞肺癌淋巴结转移规律和清扫方式的探讨. 中华肿瘤杂志, 2014, 36(6): 536-540.
15. Takizawa T, Terashima M, Koike T, et al. Lymph node metastasis in small peripheral adenocarcinoma of the lung. J Thorac Cardiovasc Surg, 1998, 116(2): 276-280.
16. Suzuki K, Nagai K, Yoshida J, et al. Clinical predictors of N2 disease in the setting of a negative computed tomographic scan in patients with lung cancer. J Thorac Cardiovasc Surg, 1999, 117(3): 593-598.
17. Takamochi K, Nagai K, Suzuki K, et al. Clinical predictors of N2 disease in non-small cell lung cancer. J Chest, 2000, 117(6): 1577-1582.
18. Misthos P, Sepsas E, Athanassiadi K, et al. Skip metastases:analysis of their clinical significance and prognosis in the IIIA stage of non-small cell lung cancer. Eur J Cardiothorac Surg, 2004, 25(4): 502-508.
19. Prenzel KL, Monig SP, Sinning JM, et al. Role of skip metastasis to mediastinal lymph nodes in non-small cell lung cancers. J Surg Oncol, 2003, 82(4): 256-260.
20. 蒋浩, 陈军, 张银文. T₁肺癌淋巴结转移规律的临床研究. 中国临床医生, 2014, 42(6): 54-55.
21. 谢远才, 李运, 王俊, 等. 直径≤3cm的周围型非小细胞肺癌纵隔淋巴结转移规律的初步研究. 中国微创外科杂志, 2010, 10(7): 577-580.

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Clinical Significance of Lymph Node inside Lung Dissection of Non-small Cell Lung Cancer in Stage T₁

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Clinical Significance of Lymph Node inside Lung Dissection of Non-small Cell Lung Cancer in Stage T₁