A standard for hilar and intrapulmonary lymph node dissection and pathological examination in early non-small cell lung cancer

Abstract

Background: There is considerable variation in the staging of lymph nodes (LNs) as part of tumor, node, metastasis (TNM) staging of non-small cell lung cancer (NSCLC). A new dissection and pathological examination standard for hilar and intrapulmonary LNs needs to be established for patients with early-stage T1-3N0M0 NSCLC.Methods: This study involved 3,002 patients with T1-3N0M0 NSCLC who underwent radical lobectomy or total pneumonectomy in the thoracic departments of 11 Chinese institutions between January 1999 and October 2013. The Cox model was applied for univariate and multivariate analyses in the examination of station 10, 11 LN and station 12, 13, 14 LN. A hilar and intrapulmonary standard (HI standard) was then established based on univariate and multiple-factor analyses conducted using the Cox model.Results: Among the 3,002 patients enrolled in the study, 2,609 underwent at least one examination of station 10, 11 LN (A1), while 393 did not undergo examination of station 10, 11 LN (A0). The A0 and A1 groups had 5-year survival rates of 76% and 80%, respectively (P=0.

Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer

“…For T1 lung cancer, only one patient (1/169, 0.60%) had lymphatic metastasis at station 9 [ 25 ]. In addition, compared to mediastinal and hilar nodes, less attention was afforded to intrapulmonary lymph nodes (station 12, 13, 14) [ 26 ]. However, intrapulmonary lymph nodes had a relatively higher metastasis risk [ 27 ].…”

Development and validation of prognostic nomogram for T1-3N0M0 non-small cell lung cancer after curative resection

“…In this large population study, six variables including age, sex, laterality, histological classification, pathological T stage, and HI Standard were reviewed [ 10 ]. We identified that five of six factors, except laterality, were correlated with OS in univariate and multivariate analysis.…”

“…The pathological characteristics included histological classification from the the International Statistical Classification of Diseases and Related Health Problems 10th Revision (Squamous cell carcinoma, Adenocarcinoma, Adenosquamous carcinoma, Others), and pathological T stage from the eighth edition of the AJCC/UICC TNM staging (T1, T2, T3). The HI Standard [ 9 , 10 ] was defined as recommendation of at least 10 examined lymph nodes, which included at least one station in 10, 11 lymph node and one station in 12, 13, 14 lymph node. Lymph nodes were either dissected in surgical resection or re-sampled by the surgeon after surgery.…”

“…The quality of the surgery, especially the lymph node dissection, would have an effect on the prognosis [ 7 , 8 ]. Our previous study suggested that the updated hilar and intrapulmonary lymph nodes quantitative standard (HI standard) provide important guidance for pulmonary lymph node dissection and pathological examination in patients with T1–3N0M0 NSCLC [ 9 , 10 ]. Additionally, previous studies revealed that some factors might have an effect on prognosis, such as the age, sex, and histological classification [ 11 , 12 ].…”

Clinical characteristics and survival outcomes of patients with pneumonectomies: A population-based study

“…Therefore, for patients undergoing a PN, strict staging should be performed before surgery, and methods such as PET-CT should be used to assess lymph node metastasis. In addition, the greater the number of lymph nodes dissected, the longer the OS may be; this is representative of the real-world situation ( 27 ). For patients with persistent hemoptysis, medical and interventional therapy are ineffective; or when intraoperative lobectomy and sleeve resection fail in patients with preoperative neoadjuvant therapy, PN is also required for lymph node advanced.…”