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    MO02 - General Thoracic and Minimally Invasive Surgery (ID 99)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      MO02.01 - Is Lower Zone Lymph Node Dissection always Mandatory in Patients with Lower Lobe Lung Cancer? (ID 1851)

      10:30 - 10:35  |  Author(s): S. Oh

      • Abstract
      • Presentation
      • Slides

      Background
      The recent UICC-IASLC classification defines lower zone lymph node metastasis, i.e., paraesophageal and pulmonary ligament lymph nodes metastasis, as p-N2 disease. Due to the relatively rare incidence of lower zone nodal involvement, however, controversies still surround regarding the clinical characteristics and the possible pathway for lower zone lymph node in patients with lower lobe lung cancer.

      Methods
      From 2009 to 2013, 257 consecutive patients underwent lobectomy with mediastinal lymph node dissection for lower lobe lung cancer. For all patients, thin-section CT scan was reviewed to investigate maximum tumor size, location and consolidation status. In a current study, radiologically “solid” tumor was defined as a tumor which constructed only by consolidation without ground glass opacity (GGO) lesions on thin-section CT scan. Several clinical factors were evaluated to identify significant predictive factors of lower zone lymph node metastasis using a multivariate analysis.

      Results
      Twenty (7.8%) patients revealed lower zone lymph node metastasis. Twelve were men and 8 were women. Patients ranged in age from 33 to 81 y, with an average of 63 y. Among them, tumors distributed especially in Segment (S) 10 (50%). All patients showed solid appearance on thin-section CT scan. A univariate analysis revealed that tumor location (S 10 or not) and solid tumors with more than 30mm in diameter were the significant predictors for lower zone lymph node metastasis (p=0.011, 0.033). Based on a multivariate analysis, these two factors were also shown to be independent predictors for lower zone nodal metastasis in patients with lower lobe lung cancer. (p=0.014, 0.034). Furthermore, the frequency of lower zone lymph node metastasis was approximately 24% for patients with solid tumors more than 30mm located in S10. On the other hand, lower zone lymph node metastasis was never seen in patients with c-T1a-b lower lobe lung cancer with GGO component.

      Conclusion
      Although lower zone lymph node metastasis is included in N2 disease, these incidences are extremely rare even in patients with lower lobe lung cancer except for those with radiologically large-sized solid tumor located in S10 field. Thus, selective dissection for lower zone lymph node could be an appropriate operative strategy in patients with small-sized lower lobe lung cancer especially with GGO predominance.

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    P1.19 - Poster Session 1 - Imaging (ID 179)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P1.19-012 - The Quality Of Consolidation In Part Solid Nodule Could Be A Predictor Of Survival (ID 3253)

      09:30 - 09:30  |  Author(s): S. Oh

      • Abstract

      Background
      The size of consolidation on thin-section computed tomography (CT) has been one of the most important preoperative prognostic factors in resected lung cancer. On the other hand, few reports mentioned the nature of consolidation as prognostic factor.

      Methods
      A retrospective study was conducted on 617 lung cancers of clinical stage IA which were resected between 2009 and 2012. Thin-section CT scans were available for all cohorts, which were reviewed by authors. Moreover authors divided lung cancers into three categories: ground glass opacity (GGO), part solid and pure solid. 235 cases are part solid nodule. We classified these 235 part solid lung cancers into two groups: homogeneous or heterogenous. The relationship between these consolidation statuses were evaluated using the chi-square test and Fisher’s exact test. The medical record of each patient was examined for investigating following clinicopathological factors: age, gender, smoking status (pack-year smoking), preoperative serum carcinoembryonic antigen (CEA), SUV max of the primary tumor on positron emission tomography (PET), pathological pleural, vascular, and lymphatic invasion. P-value <0.05 was considered statically significant.

      Results
      Ninety pts (38.3%) had homogeneous consolidation. There were 32 (35.6%) , and 56 (38.6%) men, 6 (14.6%), and tumor having 3 or more SUV max on PET was found in 6 (14.6%), 5 (10.4%), respectively. Based on univariate analysis, age, gender, and pack-year smoking were not statistically significant differences. In homogeneous consolidation group, 2 patients have nodal metastasis, however nodal metastasis were not observed in scattered consolidation group. (P=0.023) Vascular invasive was frequently found in homogeneous consolidation group. (P=0.04)

      Conclusion
      This result of our study shows that the quality of consolidation in part solid lung cancer could be the prognostic factor.