Analysis of the lymph node metastasis distribution in patients with invasive resectable non-small cell lung cancer

Congcong Xu; Jiajing Sun; Hao Liu; Baofu Chen; Sikai Wu; Hongbin Qiu; Jiawei Li; Dong Chen; Kanghao Zhu; Zixian Jin; Jian Zhang; Bo Zhang; Zhongxiao Chen; Pasan Witharana; William C Cho; Jianfei Shen

doi:10.21037/tlcr-24-450

Analysis of the lymph node metastasis distribution in patients with invasive resectable non-small cell lung cancer

Transl Lung Cancer Res. 2024 Nov 30;13(11):3039-3049. doi: 10.21037/tlcr-24-450. Epub 2024 Nov 28.

Authors

Congcong Xu^#^{1

2}, Jiajing Sun^#³, Hao Liu^#¹, Baofu Chen², Sikai Wu⁴, Hongbin Qiu¹, Jiawei Li¹, Dong Chen⁵, Kanghao Zhu⁶, Zixian Jin¹, Jian Zhang¹, Bo Zhang¹, Zhongxiao Chen¹, Pasan Witharana^{7

8}, William C Cho⁹, Jianfei Shen¹

Affiliations

¹ Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
² Department of Cardiothoracic Surgery, Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China.
³ Department of Cardiothoracic Surgery, Taizhou Hospital, Zhejiang University School of Medicine, Taizhou, China.
⁴ Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵ Department of Thoracic Surgery, Jinhua Hospital of Zhejiang University, Jinhua, China.
⁶ Department of Thoracic Surgery, Li Huili Hospital Affiliated to Ningbo University, Ningbo, China.
⁷ Northern General Hospital, Sheffield, UK.
⁸ Imperial College London, London, UK.
⁹ Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.

^# Contributed equally.

Abstract

Background: The current standard for the surgical management of lung cancer involves anatomic lung resection combined with systemic lymph node dissection/sampling. The purpose of this study was to investigate the patterns of pathological lymph nodes in invasive non-small cell lung cancer (NSCLC), explore the occurrence in lymph node metastasis (LNM), and provide recommendations for optimal lymph node resection/sampling in lung cancer operation.

Methods: There were 1,678 patients with NSCLC who underwent lobectomy between 2018 and 2021 at the Taizhou Hospital of Zhejiang Province were reviewed retrospectively. The location and incidence of LNM and postoperative pathological findings were studied. We analysed the metastasis rates of lymph node dissection stations using Pearson's χ² and Fisher's exact tests.

Results: There were 1,308 patients assessed as eligible and included in the study. The median number of lymph nodes cleared in the cohort was 11.2±5.1. In patients with lung adenocarcinoma, the rate of LNM was significantly higher in central than in peripheral lung cancer, especially in 2R/2L, L7, L9, L10, L11, and L12. Lung cancer patients with tumors ≤1 cm had no N2 lymph node metastases but few (2/191, 1.1%) N1 lymph node metastases. The likelihood of N2 metastasis increased (T1a, 0%, 0/191; T1b 3.5%, 22/625; T1c, 5.6%, 14/249; T2 and above, 18.9%, 46/243) with increasing tumor diameter. Thirty-four patients with stage N2 lung adenocarcinoma and 1-3 cm tumors displayed lobe-specific lymph node metastases in the mediastinum. In patients diagnosed with squamous cell carcinoma, no significant differences were observed in mediastinal LNM across various parameters (central versus peripheral location, tumor site, and tumor size).

Conclusions: Our study proposes recommendations for lymph node resection according to the pathological type of lung cancer, tumor location, lung lobes affected and tumor size, which may provide a certain reference value for the clinical work.

Keywords: Non-small cell lung cancer (NSCLC); lymph node dissection; lymph node metastasis (LNM); surgical technique.