Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal

Riquet, Marc; Rivera, Caroline; Pricopi, C.; Arame, Alex; Mordant, Pierre; Foucault, Christophe; Dujon, Antoine; Pimpec-Barthes, Françoise Le

doi:10.1093/ejcts/ezu226

Cited by 83 publications

(59 citation statements)

References 18 publications

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“…In our study, the significant differences in five-year OS and DFS were not observed between pN0N2a and pN1N2a patients; a result that is inconsistent with Riquet et al 9,12 In their study, five-year OS was significantly different in single station N2 patients with and without N1 involvement (24% vs. 38.4%, P = 0.0005). 9,12 In our cohort, different prognoses between different N1 status patients was only observed in pN2b patients. Because of the limited number of patients in this subgroup, our findings need to be validated in a larger cohort.…”

Section: Discussioncontrasting

confidence: 99%

Reappraisal of the role of postoperative radiation therapy in patients with pIIIa‐N2 non‐small cell lung cancer: A propensity score matching analysis

et al. 2015

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BackgroundReappraisal of the role of postoperative radiotherapy in pN2 non-small cell lung cancer (NSCLC) patients according to N1 lymph node involvement.MethodsA total of 218 pIIIa-N2 NSCLC patients who underwent complete surgical resection with systematic nodal dissections were enrolled. Propensity scores were used for matching N1 involvement. Overall survival (OS) and disease-free survival (DFS) were analyzed retrospectively.ResultsAfter matching, pN2b patients without N1 involvement (pN0N2b) exhibited better prognoses than those with N1 involvement (pN1N2b) (5-year OS: 37.5% vs. 7.1%, P = 0.008; 5-year DFS: 31.8% vs. 4.6%, P = 0.004). Similar results were not detected in pN2a disease (5-year OS: 37.8% vs. 31.0%, P = 0.517; 5-year DFS: 27.1% vs. 20.2%, P = 0.788). The five-year OS of patients who received no adjuvant therapy (22 pN2a cases, 7 pN0N2b, 5 pN1N2b), adjuvant chemotherapy alone (74 pN2a cases, 11 pN0N2b, 17 pN1N2b) or chemoradiotherapy (25 pN2a cases, 7 pN0N2b, 6 pN1N2b) were compared (pN2a: 31.3%, 37.0%, and 32.0%, P = 0.808; pN0N2b: 0.0%, 18.2%, and 71.4%, P = 0.108; pN1N2b: 0.0%, 0.0%, and 33.3%, P < 0.0001). The five-year DFS was also analyzed (pN2a: 31.6%, 24.0%, and 18.3%, P = 0.410; pN0N2b: 0.0%, 11.1%, and 57.1%, P = 0.192; pN1N2b: 0.0%, 0.0%, and 16.7%, P < 0.0001). Multivariate analysis revealed that the novel classification based on N1 involvement and pN2a/pN2b staging was an independent prognostic factor of OS and DFS.ConclusionN1 involvement significantly impacted the prognosis of pN2b NSCLC patients. The benefit of adjuvant therapy in pN2a and pN0N2b patients requires confirmation by further study.

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Section: Discussioncontrasting

confidence: 99%

Reappraisal of the role of postoperative radiation therapy in patients with pIIIa‐N2 non‐small cell lung cancer: A propensity score matching analysis

et al. 2015

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“…The 5-year overall survival was 61%, pN2 patients had a 5-year survival of 36% compared to 66% of patients with N0 disease. Other authors have reported similar survival rates for pN2 patients (4,6). However these data do not provide any evidence that MLND is superior to lobe-specific dissection, because only a few skip metastases were found in this study by MLND.…”

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confidence: 64%

Mediastinal lymph node dissection: the debate is not resolved

2017

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“…This was corroborated by Riquet et al (), whose findings revealed drainage into the ITB group from 26% of right and 10% of left upper lobe segments. The surgical series of Saeteng et al () and Riquet et al () confirm these results. They report, respectively, 5% and 9% of metastases in the ITB group for operated cancers of the right upper lobe and 6% and 35% for cancers of the left upper lobe.…”

Section: Discussionmentioning

confidence: 65%

Variations in lung lymphatic drainage into the inferior tracheobronchial lymph nodes junction: Applications in lung cancer

Ndiaye

Dimarino²,

Ndiaye

et al. 2016

Clinical Anatomy

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The group of inferior tracheobronchial lymph nodes (ITB) is a lymphatic junction through which the lymph from both lungs is carried. Lymphatic activity in this area can be used to assess the lymphatic spreading of lung cancers. Our aim was to quantify lymph drainage from the lung segments towards the ITB group and to determine the direction of the lymph flow into other mediastinal and abdominal lymph nodes. We injected dye directly into the subpleural lymphatic vessels in 100 lung segments of 25 fresh cadaver subjects; the cadavers were then dissected. Thirty-eight segments (38%) drained into the ITB group in 18 subjects. The drainage into the ITB group involved 15.6% of the upper lobe segments, 87.5% of the middle lobe segments, and 70.6% of the lower lobe segments in the right lung. On the left, 6.9% of the upper lobe segments and 83.3% of the lower lobe segments were drained into the ITB group. For three subjects, the dye did not pass beyond the ITB group. The efferent vessels of the ITB group drained towards the right paratracheal and tracheoesophageal chains in 12 subjects and through the left ascending recurrent chain in five subjects. For six subjects, the efferent channels reached the abdominal lymph nodes. A contralateral drainage involved 14 segments (36%). The size and variety of the segments that drain into the ITB group, coupled with the efferent contralateral mediastinal and abdominal pathways, account for the severity of metastasis to this area. Clin. Anat. 29:955-962, 2016. © 2016 Wiley Periodicals, Inc.

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Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal

Abstract: Tumour location is not a predictor of nodal metastasis pattern. In surgical treatment of NSCLC, complete systematic mediastinal LN dissection remains the only acceptable procedure from an oncological point of view.

Cited by 83 publications

References 18 publications

Reappraisal of the role of postoperative radiation therapy in patients with pIIIa‐N2 non‐small cell lung cancer: A propensity score matching analysis

Reappraisal of the role of postoperative radiation therapy in patients with pIIIa‐N2 non‐small cell lung cancer: A propensity score matching analysis

Mediastinal lymph node dissection: the debate is not resolved

Variations in lung lymphatic drainage into the inferior tracheobronchial lymph nodes junction: Applications in lung cancer

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