Clinical Significance of 4L Lymph Node Dissection in Left Lung Cancer

Wang, Ya Nan; Yao, Shuang; Wang, Changli; Li, Mei Shuang; Sun, Lei; Yan, Qing; Tang, Shaowen; Zhang, Zhen Fa

doi:10.1200/jco.2018.78.7101

Cited by 35 publications

(39 citation statements)

References 26 publications

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“…Because of the deep anatomic location of 4L lymph node, which lies to the left of the left lateral border of the trachea and medial to the ligamentum arteriosum enveloped by aortic arch and left pulmonary artery, 8 dissection of 4L lymph node is technically challenging with high risk of left recurrent laryngeal nerve paralysis 9 . Therefore, some thoracic surgeons chose to neglect 4L LND for left‐sided NSCLC 10,11 . However, recent evidence showed that dissection of 4L lymph node could benefit patients with left‐sided NSCLC, 11–13 arguing for the necessity of 4L LND for left‐sided NSCLC.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, some thoracic surgeons chose to neglect 4L LND for left‐sided NSCLC 10,11 . However, recent evidence showed that dissection of 4L lymph node could benefit patients with left‐sided NSCLC, 11–13 arguing for the necessity of 4L LND for left‐sided NSCLC. However, previous evidence for the benefit of 4L LND for left‐sided NSCLC is limited due to the small sample size of individual study and retrospective study design, 11–13 and as a result, meta‐analysis pooling of all available relevant evidence together is needed for robust validity.…”

Section: Introductionmentioning

confidence: 99%

“…However, recent evidence showed that dissection of 4L lymph node could benefit patients with left‐sided NSCLC, 11–13 arguing for the necessity of 4L LND for left‐sided NSCLC. However, previous evidence for the benefit of 4L LND for left‐sided NSCLC is limited due to the small sample size of individual study and retrospective study design, 11–13 and as a result, meta‐analysis pooling of all available relevant evidence together is needed for robust validity. Therefore, we conducted the first systematic review and meta‐analysis to elucidate the effects of 4L LND on survival of patients with left‐sided NSCLC, aiming to justify for advocating 4L LND for left‐sided NSCLC.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dissection of 4L lymph node for left‐sided non‐small cell lung cancer: a meta‐analysis

Deng

Qiu

et al. 2021

ANZ Journal of Surgery

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Background Whether dissection of left lower paratracheal (4L) lymph node has any impact on survival of patients with left‐sided non‐small cell lung cancer (NSCLC) remains unclear. We conducted the first meta‐analysis to compare the survival of patients treated with 4L lymph node dissection (LND) and those without for left‐sided NSCLC. Methods We systematically searched relevant studies from PubMed, Embase, and Web of Science on February 6, 2020. Data for analysis included 5‐year overall survival (OS) and disease‐free survival (DFS) rates, OS, and DFS. We calculated risk ratio (RR) for pooling 5‐year OS and DFS rates and extracted hazard ratio (HR) from multivariate analysis for pooling OS and DFS. Results We finally included three retrospective cohort studies with propensity score‐matched analysis consisting of 2103 patients. Meta‐analysis showed that patients treated with 4L LND yielded significantly higher 5‐year OS (67.7% vs. 54.6%; fixed effects models: RR = 0.75; 95% confidence interval [CI] = [0.67, 0.84]; p < 0.001; I2 = 0%) and DFS (53.3% vs. 44.8%; fixed effects models: RR = 0.85; 95% CI = [0.76, 0.95]; p = 0.003; I2 = 41.7%) rates than patients without 4L LNDS. Moreover, dissection of 4L lymph node was significantly associated with better OS (fixed effects model: HR = 0.66; 95% CI = [0.57, 0.76]; p < 0.001; I2 = 45.7%) and DFS (fixed effects model: HR = 0.67; 95% CI = [0.52, 0.87]; p = 0.003; I2 = 0%). No significant heterogeneities were observed. Conclusions Dissection of 4L lymph node could significantly improve both 5‐year OS and DFS rates and 4L LND was a favorable prognostic factor for patients with left‐sided NSCLC.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dissection of 4L lymph node for left‐sided non‐small cell lung cancer: a meta‐analysis

Deng

Qiu

et al. 2021

ANZ Journal of Surgery

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“…Non-small cell lung cancer (NSCLC) tumor cells usually appear in regional lymph nodes before they are detected in distant organs. The presence of lung cancer cells in lymph nodes is a major indicator in the staging of NSCLC and is associated with poor prognosis 4 , 5 . Tumor lymphangiogenesis is strongly correlated with increased incidence of lymph node metastasis and decreased overall survival in several types of human cancers 6 – 8 and experimental cancer models 9 – 11 .…”

Section: Introductionmentioning

confidence: 99%

Anlotinib suppresses lymphangiogenesis and lymphatic metastasis in lung adenocarcinoma through a process potentially involving VEGFR-3 signaling

et al. 2020

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“…For example, the metastasis of other lymph nodes may affect the 4L lymph node metastasis and the tumor size. However, by a multivariate analysis, they all found positive left hilar lymph node result, which might be one of the independent risk factor for 4L lymphatic metastasis (22)(23)(24). This is consistent with our conclusion, which provides thoracic surgeons an indication: The intraoperative rapid frozen section pathological examination of station 10L lymph node may be a good choice.…”

Section: Discussionmentioning

confidence: 99%

Significance of risk factor analysis and dissection for station 4L lymphatic metastasis in left lung cancer: a systematic review and meta-analysis

Wang¹,

Xu²,

Li³

et al. 2021

Transl Cancer Res TCR

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Background: The effect of 4L lymph node dissection on the prognosis of left lung cancer is currently controversial. Therefore, a meta-analysis was conducted to compare the difference in prognosis between the dissection group and the non-dissection group, and assess the independent risk factors for 4L lymphatic metastasis.Methods: A systematic literature retrieval from PubMed, Embase and CNKI was conducted to identify relevant studies up to October, 5, 2020. The data concerning the overall survival (OS) rate, disease-free survival (DFS) rate, and risk factors for 4L lymphatic metastasis were extracted and analyzed.Results: L10 lymphatic metastasis was an independent risk factor for positive L4 lymph node result (Z=4.89, P<0.05). The probability of positive L4 with positive L10 was 5.11 times of that with negative L10. L5 lymphatic metastasis was an independent risk factor for positive L4 lymph node result (Z=3.92, P<0.05). The probability of positive L4 with positive L5 was 3.92 times of that with negative L5. L7 lymphatic metastasis was not an independent risk factor for positive L4 lymph node result. Positive L4 lymph node decreased the survival rate of relevant patients while L4 lymph node dissection increased the survival rate of relevant patients (Z=2.81, P<0.05 or Z=4.18, P<0.05). Positive L4 lymph node reduced the DFS time of relevant patients while L4 lymph node dissection prolonged the DFS time of relevant patients (P<0.05, Z=2.72).Conclusions: If the intraoperative pathological examination indicates positive station 10L lymph node, station 4L lymph node will be dissected, which may be a good choice at present. Positive L4 lymph node may reduce the survival time and DFS time of relevant patients while dissection of positive station 4L lymph node may prolong the survival time and DFS time of relevant patients. The intraoperative rapid frozen section pathological examination of station 10L lymph node may be a good choice.

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Clinical Significance of 4L Lymph Node Dissection in Left Lung Cancer

Abstract: Station 4L LN involvement is not rare in left lung cancer, and dissection of the 4L LN station seems to be associated with a more favorable prognosis as compared with those who did not undergo this dissection.

Cited by 35 publications

References 26 publications

Dissection of 4L lymph node for left‐sided non‐small cell lung cancer: a meta‐analysis

Dissection of 4L lymph node for left‐sided non‐small cell lung cancer: a meta‐analysis

Anlotinib suppresses lymphangiogenesis and lymphatic metastasis in lung adenocarcinoma through a process potentially involving VEGFR-3 signaling

Significance of risk factor analysis and dissection for station 4L lymphatic metastasis in left lung cancer: a systematic review and meta-analysis

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