Mediastinal Nodal Involvement in Patients with Clinical Stage I Non–Small-Cell Lung Cancer: Possibility of Rational Lymph Node Dissection

Haruki, Tomohiro; Aokage, Keiju; Miyoshi, Tomohiro; Hishida, Tomoyuki; Ishii, Genichiro; Tsuboi, Masahiro; Nakamura, Hiroshige; Nagai, Kanji

doi:10.1097/jto.0000000000000546

Cited by 63 publications

(44 citation statements)

References 31 publications

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“…That fact supports the suggestion that MLE is not required in GGO-predominant tumor. In previous studies, the incidence of mediastinal lymph node metastasis has been very low in GGO-predominant early stage NSCLC (11,24). This study also found that there was no mediastinal lymph node metastasis in GGO-predominant tumor.…”

Section: Discussionsupporting

confidence: 53%

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

et al. 2016

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Background: The prognosis of non-small cell lung cancer (NSCLC) presenting as a ground glass opacity (GGO) nodule is better than other types of lung cancer. The purpose of this study was to evaluate the necessity of mediastinal lymph node evaluation (MLE) in clinical N0 GGO-predominant NSCLC. Methods:We conducted a retrospective chart review of 358 patients treated for clinical N0 NSCLC that was found by curative resection to be 3 cm or smaller in size. We analyzed clinicopathological findings and survival among three groups with either GGO-predominant or solid-predominant tumor: no mediastinal lymph node evaluation (NoMLE) group, mediastinal lymph node sampling (MLS) group, and mediastinal lymph node dissection (MLND) group.Results: Except for sex, there were no differences in clinicopathological characteristics among the three groups with GGO-predominant tumor or solid-predominant tumor. There was no difference in the 5-year recurrence-free survival (RFS) rate among three groups in the GGO-predominant patients (100%, 92.9%, 93.8%, respectively; P=0.889). However, in the solid-predominant tumor group, the 5-year recurrence free survival of the NoMLE group was lower than in the MLND group (48.6% vs. 73.1%, P=0.007). MLE was not a significant risk factor for recurrence in GGO-predominant tumor [hazard ratio (HR) =1.021; P=0.987].GGO-predominant tumor [odds ratio (OR) =0.063; P=0.008] was identified as the sole parameter that significantly impacted nodal upstaging.Conclusions: MLE is not an essential procedure for clinical N0 NSCLC presenting as a 3 cm or smaller GGO-predominant nodule.

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Section: Discussionsupporting

confidence: 53%

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

et al. 2016

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“…Both SCN (24) and SMN metastasis (25) in the lower lobe indicated poor prognosis. Based on such findings, SMN dissection may be unnecessary for right lower lobe NSCLC patients when hilar lymph node and SCN are both intraoperatively intact (17,20,26).…”

Section: Lower Lobesmentioning

confidence: 99%

“…In addition, Haruki (26) elucidated that CEA elevation was highly associated with SMN metastasis in lower lobe clinical-stage I adenocarcinoma. Based on these studies, it is reasonable to preserve SMN for lower lobe clinical-stage I NSCLC patients with a normal level of CEA (26). However, we need more evidence to confirm the significance of CEA and elucidate the role of other tumor markers.…”

Section: Tumor Markermentioning

confidence: 99%

Selective lymph node dissection in early-stage non-small cell lung cancer

Han

Chen

2017

J. Thorac. Dis.

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Lymph node dissection is a vital part of surgical treatment in early-stage non-small cell lung cancer (NSCLC). Removal of metastatic lymph nodes while preservation of intact lymph nodes are equally important. For hospitalized early-stage patients with limited lymph node metastasis, the operation treatment should be made according to some rules such as lobe-specific lymph node drainage pattern. In order to prevent unnecessary surgical trauma in early-stage patients, a minimally invasive approach with selective lymph node excision is preferred for more clinical benefits. This review summarizes the existing findings on lobe-specific lymph node drainage pattern and we hope to provide guidance for selective lymph node dissection (SLND). Furthermore, we include information on histologic views, a tumor marker and protocols of SLND, with hope to inspire creative research and clinical trials in this field.

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“…The study suggested that lobe-specific selective lymph node dissection (LSLND) may be acceptable in GGO-predominant cases. Moreover, hilar and mediastinal LND may even be unnecessary in GGO-predominant lung cancer (13). In a retrospective registry study from Japan with 5,392 patients with c-stage I or II NSCLC, LSLND and SLND were performed in 1,268 patients (23.5%) and 4,124 patients (76.5%), respectively.…”

Section: Editorialmentioning

confidence: 99%

Mediastinal lymph node resection in stage IA non-small cell lung cancer with small nodule: is it mandatory?

Kim

2017

J. Thorac. Dis.

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Mediastinal Nodal Involvement in Patients with Clinical Stage I Non–Small-Cell Lung Cancer: Possibility of Rational Lymph Node Dissection

Cited by 63 publications

References 31 publications

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

Selective lymph node dissection in early-stage non-small cell lung cancer

Mediastinal lymph node resection in stage IA non-small cell lung cancer with small nodule: is it mandatory?

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