Clinicopathological Characteristics of Lung Adenocarcinoma with Unexpected Lymph Node Metastasis

Haruki, Tomohiro; Wakahara, Makoto; Matsuoka, Yuki; Miwa, Koichi; Araki, Koji; Taniguchi, Yoshihiro; Nakamura, Hiroshige

doi:10.5761/atcs.oa.16-00309

Cited by 14 publications

(13 citation statements)

References 21 publications

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“…Our findings agreed with the majority of previous studies concluding that young age was an independent predictor of LN metastasis in NSCLC [17][18][19][20][21] . However, some of the previous studies also showed that age did not significantly influence the risk of LN metastasis in NSCLC 11,22,23 .…”

Section: Commentsupporting

confidence: 93%

“…For example, some studies only focused on clinical stage I NSCLC 11,22,23 while others focused on resectable NSCLC (clinical stage I-III) 20 . Moreover, some studies calculated age as categorical data [17][18][19][20][21] while others analyzed age as continuous data 10 . Nearly all these previous studies finding no correlation between age and LN metastasis had a relatively limited sample size (<300 cases) 11,22,23 .…”

Section: Commentmentioning

confidence: 99%

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Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Deng

Zhou

Wang

et al. 2020

Sci Rep

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Whether age has any impact on the risk of lymph node (LN) metastasis in patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. Therefore, we aimed to objectively compare the risk of LN metastasis between elderly and young patients so as to justify for age-different extent of surgical resection for treating these patients. We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic hilar and mediastinal LN dissection for clinical stage IA peripheral NSCLC from January 2015 to December 2018. Both multivariate logistic regression analysis and propensity score-matched (PSM) analysis were applied to compare the risk of LN metastasis between elderly (>65 years old) and young (≤65 years old) patients. We finally included a total of 590 patients for analysis (142 elderly patients and 448 young patients). In the analysis of unmatched cohorts, young patients tended to have higher rates of hilar/intrapulmonary LN (13.4% VS 9.2%) and mediastinal LN metastasis (10.5% VS 6.3%) than elderly patients. In the multivariate analysis, age was found to be an independent predictor of both hilar/intrapulmonary (Odds ratio(OR) = 2.065, 95%confidence interval(CI): 1.049-4.064, P = 0.036) and mediastinal (OR = 2.400, 95%CI: 1.083-5.316, P = 0.031) LN metastasis. Moreover, in the analysis of well-matched cohorts generated by PSM analysis, young patients had significantly higher rates of hilar/intrapulmonary (18.8% VS 9.4%, P = 0.039) and mediastinal LN metastasis (17.1% VS 6.0%, P = 0.008) than elderly patients. Therefore, age remains to be an independent predictor of LN metastasis in early-stage NSCLC and age-different extent of surgical resection may be justified for these patients. Lung cancer has become the leading cause of cancer and cancer-related death worldwide 1 .There are two major types of lung cancer, namely small cell lung cancer(SCLC) and non-small cell lung cancer(NSCLC), of which NSCLC accounted for about 85% 2. With the advancement of computed tomography (CT), more and more early-stage NSCLCs are being found 3,4. For the management of early-stage NSCLC, anatomic lung resection with systematic lymph node (LN) dissection (SLND) or sampling is recommended as the preferred option in the National Comprehensive Cancer Network guideline 5. However, the extent of lung resection and lymphadenectomy for treating early-stage NSCLC depends largely on the characteristics of tumors such as tumor size, status of LN metastasis, histology as well as ground glass consistency 6 and the patient's physiological conditions. It is reported that the age at diagnosis for majority of early-stage NSCLC patients falls into the range from 65 to 79 years old 7 and the number of elderly patients continues to increase with the aging population. Moreover, significant difference of baseline characteristics between elderly and young lung cancer patients was observed 8. However, current guideline still recommends the same surgical strategies for elderly and young patients except fo...

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Section: Commentsupporting

confidence: 93%

Section: Commentmentioning

confidence: 99%

Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Deng

Zhou

Wang

et al. 2020

Sci Rep

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“…Histologic subtype in lung adenocarcinoma has been shown to have a strong association with occult nodal metastasis (9,(22)(23)(24)(25). Dai et al (22) reported that presence of a micropapillary component was an independent predictor of a higher possibility of micrometastasis.…”

Section: Discussionmentioning

confidence: 99%

Novel approach for predicting occult lymph node metastasis in peripheral clinical stage I lung adenocarcinoma

Song¹,

Kimura²,

Sakai³

et al. 2019

J. Thorac. Dis

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Background: Occult nodal metastasis results in a poor prognosis for lung cancer patients. The aim of this study was to develop an efficient approach for predicting occult nodal metastasis in peripheral clinical stage I lung adenocarcinoma. Methods: Data for 237 peripheral clinical stage I lung adenocarcinoma patients who underwent complete resection were retrospectively reviewed. Univariate and multivariate analyses were performed to investigate predictors of occult nodal metastasis. Kaplan-Meier analysis was performed for survival. Results: Occult nodal metastasis was detected in 26/237 (11.0%) patients. Nodule type, tumor SUVmax, whole tumor size, solid tumor size, and preoperative serum carcinoembryonic antigen (CEA) were identified as preoperative predictors of occult nodal metastasis (all P<0.05). Solid tumor size (P<0.001) and preoperative serum CEA (P=0.004) were identified as independent predictors on multivariate analysis. A prediction model was established using the independent predictors. The occult nodal metastasis rate was 2.4% with solid tumor size ≤2.3 cm (low-risk group), 17.0% with solid tumor size >2.3 cm and CEA ≤5 ng/mL (moderate-risk group), and 56.0% with solid tumor size >2.3 cm and CEA >5 ng/mL (high-risk group). The occult nodal metastasis rate was significantly higher in papillary-predominant (11.0%) and solid-predominant subtypes (28.6%; P=0.001). Patients having a micropapillary component had a significantly higher occult nodal metastasis rate (24.2%) compared with no micropapillary component (P=0.007). Histological subtype with micropapillary component and all preoperative predictors were significant prognostic factors affecting disease-free survival (DFS) (all P<0.05). Conclusions: A novel approach to predict occult nodal metastasis was developed for peripheral clinical stage I lung adenocarcinoma. It would be helpful for selecting candidates for stereotactic ablative radiotherapy (SABR) or wedge resection and mediastinoscopy or endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). Complete nodal dissection should be performed for moderate to high-risk patients or patients with poor histologic subtypes.

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“…Lymph node metastasis suggests that the local invasiveness of the tumor is significantly enhanced, affecting the diagnostic yield of bronchoscopy 12. In addition, it is a major factor affecting the prognosis of patients 21 and correlates with the tumor diameter and micropapillary subtype adenocarcinoma 22,23. The number of patients with the bronchus cutoff sign was 48 cases, and the endoscopic diagnostic yield was 60.4%.…”

Section: Discussionmentioning

confidence: 99%

<p>Multivariate Analysis Of The Diagnostic Yield Of Conventional Bronchoscopy In Peripheral Lung Adenocarcinoma</p>

Gao¹,

Li²,

Wang³

et al. 2019

CMAR

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BackgroundThe new subtypes of lung adenocarcinoma reflect local invasive growth, pulmonary alveoli, and intraluminal spreading, while the effective improvement of the diagnostic yield of bronchoscopy still remains unclear. This study aims to explore whether the subtypes of lung adenocarcinoma and other factors affect the diagnostic yield of bronchoscopy.MethodsAll patients were performed 64-row CT examination and bronchoscopy.ResultsThe bronchus cutoff sign in 48 cases and the endoscopic diagnostic yield was 60.4%. The lumen of the lobes and segments was invaded in 59 cases, and the endoscopic diagnostic yield was 54.2%.The lymph node metastasis was detected in 46 cases, and the endoscopic diagnostic yield was 60.9%. In addition, 42 cases showed acinar type-predominant, and the endoscopic diagnostic yield was 28.6%. Eighteen cases showed solid type-predominant, and the endoscopic diagnostic yield was 33.3%. The micropapillary type-predominant was noted in 17 cases, with the endoscopic diagnostic yield as 94.1%. The papillary type-predominant was in 14 cases, and the endoscopic diagnostic yield was 42.9%. The lepidic type-predominant was seen in 13 cases, and the endoscopic diagnostic yield was 7.7%. The mean diameter of tumors with a positive endoscopic diagnostic yield was 4.34±2.65cm, and the mean diameter of tumors with a negative diagnostic yield was 2.83±1.47cm. Multivariate analysis showed that micropapillary lung adenocarcinoma affected the endoscopic diagnostic yield (OR=37.594, 95% CI: 4.074–346.94) .Tumor diameter affects endoscopic diagnostic yield (OR=1.39, 95% CI: 1.073–1.802), bronchus cutoff sign is easy to obtain endoscopic diagnostic yield (OR=4.86, 95% CI: 1.606–14.704), and lymph node metastasis affects the endoscopic diagnostic yield (OR=3.696, 95% CI: 1.255–10.883).ConclusionThe micropapillary subtype lung adenocarcinoma has a certain influence on the diagnostic yield of bronchoscopy. When the lung adenocarcinoma has a large tumor diameter, bronchus cutoff sign and lymph node metastasis, it is easy to obtain a diagnostic yield of bronchoscopy.

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Clinicopathological Characteristics of Lung Adenocarcinoma with Unexpected Lymph Node Metastasis

Cited by 14 publications

References 21 publications

Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Novel approach for predicting occult lymph node metastasis in peripheral clinical stage I lung adenocarcinoma

<p>Multivariate Analysis Of The Diagnostic Yield Of Conventional Bronchoscopy In Peripheral Lung Adenocarcinoma</p>

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