Metastatic pattern of No.13 and No.14 intrapulmonary lymph nodes in patients with peripheral non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

BI Lei ¹ , ZHANG Hong ² , LV Zhongzhu ¹ , DENG Yiping ¹ , RONG Tenghao ¹ , LIU Chaolun ¹ ,  GE Mingjian ³

1. Department of Cardiothoracic Surgery, The People’s Hospital of Bishan District, Chongqing, 402760, P.R.China;
2. Department of Traditional Chinese Medicine, The People’s Hospital of Bishan District, Chongqing, 402760, P.R.China;
3. Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, P.R.China;

Corresponding author：

GE Mingjian, Email: gemingjian@yeah.net

Keywords：

Lung neoplasms; intrapulmonary lymph node; lymph node metastasis; lymph node dissection

DOI：

10.7507/1007-4848.202001052

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Objective To explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC).Methods The clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed. There were 159 males and 75 females, aged 36-89 (61.35±8.57) years. Statistical analysis was performed accordingly on hilar (No.10), interlobar (No.11), lobar (No.12) and segmental (No.13 and 14) sites of the samples of N1 lymph nodes after surgery.Results A total of 3 019 lymph nodes of No.10-14 were dissected in 234 patients (12.9 per patient). The 263 lymph nodes were positive with a rate of 8.71% (263/3 019) and lymph node metastasisa occured in 99 patients with a rate of 42.31% (99/234), among whom there were 40 patients of N1 metastasis, 48 of N1+N2 metastasis and 11 of N2 skipping metastasis. Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84% (16/234). In 886 dissected lymph nodes of No.13 and No.14, 86 lymph nodes showed metastasis with a rate of 9.71% (86/886). Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 56.32% of them were confirmed with lymph node metastasis by postoperative histopathology; while 34.01% of the patients with normal size lymph nodes had lymph node metastasis.Conclusion In the surgical treatment of NSCLC, it is necessary to detect the metastasis of No. 13 and 14 lymph nodes and non-tumor parabronchial lymph nodes, which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment. Preoperative CT is not a reliable method to judge lymph node metastasis, particularly for intrapulmonary lymph node metastasis.

Citation： BI Lei, ZHANG Hong, LV Zhongzhu, DENG Yiping, RONG Tenghao, LIU Chaolun, GE Mingjian. Metastatic pattern of No.13 and No.14 intrapulmonary lymph nodes in patients with peripheral non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(10): 1201-1206. doi: 10.7507/1007-4848.202001052 Copy

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14.	Wang J, Liu F, Huang DX, <italic>et al</italic>. Post-operative treatment with cisplatin and vinorelbine in Chinese patients with non-small cell lung cancer: a clinical prospective analysis of 451 patients. Asian Pac J Cancer Prev, 2012, 13(9): 4505-4510.
15.	Okada M, Nishio W, Sakamoto T, <italic>et al</italic>. Long-term survival and prognostic factors of five-year survivors with complete resection of non-small cell lung carcinoma. J Thorac Cardiovasc Surg, 2003, 126(2): 558-562.
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17.	Osarogiagbon RU, Hilsenbeck HL, Sales EW, <italic>et al</italic>. Improving the pathologic evaluation of lung cancer resection specimens. Transl Lung Cancer Res, 2015, 4(4): 432-437.
18.	Watanabe S. Lymph node dissection for lung cancer: past, present, and future. Gen Thorac Cardiovasc Surg, 2014, 62(7): 407-414.
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24.	逄旭光, 蒋伟, 王群, 等. 早期非小细胞肺癌淋巴结清扫范围的探讨. 中国临床医学, 2012, 19(6): 616-618.
25.	谢远才, 李运, 王俊, 等. 直径≤3 cm的周围型非小细胞肺癌纵淋巴结转移规律的初步研究. 中国微创外科志, 2010, 10(7): 577-580.
26.	陈健, 许凝, 栗新燕. T1 期非小细胞肺癌清扫肺内淋巴结的临床意义. 中国胸心血管外科临床杂志, 2016, 23(4): 341-345.
27.	Matsumura Y, Hishida T, Yoshida J, <italic>et al</italic>. Reasonable extent of lymph node dissection in intentional segmentectomy for small-sized peripheral non-small-cell lung cancer: from the clinicopathological findings of patients who underwent lobectomy with systematic lymph node dissection. J Thorac Oncol, 2012, 7(11): 1691-1697.
28.	马海波, 丁志丹, 曲戈, 等. 非小细胞肺癌隆突下淋巴结转移与临床病理特征的关系. 中国胸心血管外科临床杂志, 2013, 20(1): 70-73.
29.	Liang W, He J, Shen Y, <italic>et al</italic>. Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: A population study of the US SEER database and a Chinese multi-institutional registry. J Clin Oncol, 2017, 35(11): 1162-1170.
30.	张磊, 布仁吉雅, 王宇飞, 等. 非小细胞肺癌13 组、14 组淋巴结转移规律探讨. 中国肺癌杂志, 2017, 20(4): 248-252.
31.	崔岳, 杨晓军, 谢天鹏, 等. 非小细胞肺癌肺内淋巴结转移规律的临床研究. 中国胸心血管外科临床杂志, 2016, 23(10): 982-987.
32.	Zhang DG, Chen XC, Zhu DX, <italic>et al</italic>. Intrapulmonary lymph node metastasis is common in clinically staged ⅠA adenocarcinoma of the lung. Thoracic cancer, 2019, 10(2): 123-127.
33.	Smeltzer MP, Faris N, Yu X, <italic>et al</italic>. Missed intrapulmonary lymph node metastasis and survival after resection of non-small cell lung cancer. Ann Thorac Surg, 2016, 102(2): 448-453.
34.	Dai C, Shen J, Ren Y, <italic>et al</italic>. Choice of surgical procedure for patients with non-small-cell lung cancer ≤ 1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study. J Clin Oncol, 2016, 34(26): 3175-3182.

1. Siegel R, Ma J, Zou Z, <italic>et al</italic>. Cancer statistics, 2014. CA Cancer J Clin, 2014, 64(1): 9-29.
2. 陈万青, 郑荣寿, 张思维, 等. 2012 年中国恶性肿瘤发病和死亡分析. 中国肿瘤, 2015, 24(1): 1-8.
3. Nasir BS, Bryant AS, Minnich DJ, <italic>et al</italic>. The efficacy of restaging endobronchial ultrasound in patients with non-small cell lung cancer after preoperative therapy. Ann Thorac Surg, 2014, 98(3): 1008-1012.
4. Donington JS, Pass HI. Surgical resection of non-small cell lung cancer with N2 disease. Thorac Surg Clin, 2014, 24(4): 449-456.
5. Darling GE, Allen MS, Decker PA, <italic>et al</italic>. Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective American College of Surgeons Oncology Group Z0030 trial. Chest, 2010, 139(5): 1124-1129.
6. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg, 1978, 76(6): 832-839.
7. Vegar Zubović S, Kristić S, Hadžihasanović B. Positron emission tomography/computed tomography (PET/CT) and CT for N staging of non-small cell lung cancer. Med Glas (Zenica), 2017, 14(2): 199-203.
8. Kim AW. Lymph node drainage patterns and micrometastasis in lung cancer. Semin Thorac Cardiovasc Surg, 2009, 21(4): 298-308.
9. Detterbeck FC, Boffa DJ, Kim AW, <italic>et al</italic>. The eighth edition lung cancer stage classification. Chest, 2017, 151(1): 193-203.
10. Ettinger DS, Wood DE, Akerley W, <italic>et al</italic>. NCCN guidelines insights: non-small cell lung cancer, version 4. 2016. J Natl Compr Canc Netw, 2016, 14(3): 255-264.
11. Beigelman-Aubry C, Dunet V, Brun AL. CT imaging in pre-therapeutic assessment of lung cancer. Diagn Interv Imaging, 2016, 97(10): 973-989.
12. Bustos García de Castro A, Ferreirós Domínguez J, Delgado Bolton R, <italic>et al</italic>. PET-CT in presurgical lymph node staging in non-small cell lung cancer: the importance of false-negative and false-positive findings. Radiologia, 2017, 59(2): 147-158.
13. Ahmad U, Crabtree TD, Patel AP, <italic>et al</italic>. Adjuvant chemotherapy is associated with improved survival in locally invasive node negative non-small cell lung cancer. Ann Thorac Surg, 2017, 104(1): 303-307.
14. Wang J, Liu F, Huang DX, <italic>et al</italic>. Post-operative treatment with cisplatin and vinorelbine in Chinese patients with non-small cell lung cancer: a clinical prospective analysis of 451 patients. Asian Pac J Cancer Prev, 2012, 13(9): 4505-4510.
15. Okada M, Nishio W, Sakamoto T, <italic>et al</italic>. Long-term survival and prognostic factors of five-year survivors with complete resection of non-small cell lung carcinoma. J Thorac Cardiovasc Surg, 2003, 126(2): 558-562.
16. Ramirez RA, Wang CG, Miller LE, <italic>et al</italic>. Incomplete intrapulmonary lymph node retrieval after routine pathologic examination of resected lung cancer. J Clin Oncol, 2012, 30(23): 2823-2828.
17. Osarogiagbon RU, Hilsenbeck HL, Sales EW, <italic>et al</italic>. Improving the pathologic evaluation of lung cancer resection specimens. Transl Lung Cancer Res, 2015, 4(4): 432-437.
18. Watanabe S. Lymph node dissection for lung cancer: past, present, and future. Gen Thorac Cardiovasc Surg, 2014, 62(7): 407-414.
19. Tournoy KG, Maddens S, Gosselin R, <italic>et al</italic>. Integrated FDG-PET/CT does not make invasive staging of the intrathoracic lymph nodes in non-small cell lung cancer redundant: a prospective study. Thorax, 2007, 62(8): 696-701.
20. Shim SS, Lee KS, Kim BT, <italic>et al</italic>. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology, 2005, 236(3): 1011-1019.
21. Schreyögg J, Weller J, Stargardt T, <italic>et al</italic>. Cost-effectiveness of hybrid PET/CT for staging of non-small cell lung cancer. J Nucl Med, 2010, 51(11): 1668-1675.
22. Park SY, Yoon JK, Park KJ, <italic>et al</italic>. Prediction of occult lymph node metastasis using volume-based PET parameters in small-sized peripheral non-small cell lung cancer. Cancer Imaging, 2015, 15: 21.
23. Watanabe S, Oda M, Go T, <italic>et al</italic>. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg, 2001, 20(5): 1007-1011.
24. 逄旭光, 蒋伟, 王群, 等. 早期非小细胞肺癌淋巴结清扫范围的探讨. 中国临床医学, 2012, 19(6): 616-618.
25. 谢远才, 李运, 王俊, 等. 直径≤3 cm的周围型非小细胞肺癌纵淋巴结转移规律的初步研究. 中国微创外科志, 2010, 10(7): 577-580.
26. 陈健, 许凝, 栗新燕. T1 期非小细胞肺癌清扫肺内淋巴结的临床意义. 中国胸心血管外科临床杂志, 2016, 23(4): 341-345.
27. Matsumura Y, Hishida T, Yoshida J, <italic>et al</italic>. Reasonable extent of lymph node dissection in intentional segmentectomy for small-sized peripheral non-small-cell lung cancer: from the clinicopathological findings of patients who underwent lobectomy with systematic lymph node dissection. J Thorac Oncol, 2012, 7(11): 1691-1697.
28. 马海波, 丁志丹, 曲戈, 等. 非小细胞肺癌隆突下淋巴结转移与临床病理特征的关系. 中国胸心血管外科临床杂志, 2013, 20(1): 70-73.
29. Liang W, He J, Shen Y, <italic>et al</italic>. Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: A population study of the US SEER database and a Chinese multi-institutional registry. J Clin Oncol, 2017, 35(11): 1162-1170.
30. 张磊, 布仁吉雅, 王宇飞, 等. 非小细胞肺癌13 组、14 组淋巴结转移规律探讨. 中国肺癌杂志, 2017, 20(4): 248-252.
31. 崔岳, 杨晓军, 谢天鹏, 等. 非小细胞肺癌肺内淋巴结转移规律的临床研究. 中国胸心血管外科临床杂志, 2016, 23(10): 982-987.
32. Zhang DG, Chen XC, Zhu DX, <italic>et al</italic>. Intrapulmonary lymph node metastasis is common in clinically staged ⅠA adenocarcinoma of the lung. Thoracic cancer, 2019, 10(2): 123-127.
33. Smeltzer MP, Faris N, Yu X, <italic>et al</italic>. Missed intrapulmonary lymph node metastasis and survival after resection of non-small cell lung cancer. Ann Thorac Surg, 2016, 102(2): 448-453.
34. Dai C, Shen J, Ren Y, <italic>et al</italic>. Choice of surgical procedure for patients with non-small-cell lung cancer ≤ 1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study. J Clin Oncol, 2016, 34(26): 3175-3182.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Metastatic pattern of No.13 and No.14 intrapulmonary lymph nodes in patients with peripheral non-small cell lung cancer

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