Author of

• 11794

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  P2.12 - Poster Session 2 - NSCLC Early Stage (ID 205)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11815

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    P2.12-021 - Selective mediastinal lymph node dissection for cN0 non-small cell lung cancer (ID 3343)

    09:30 - 09:30  |  Author(s): J. Usuda
    • Abstract

    Background
    As lobe-specific patterns of nodal metastases of lung cancer have become recognized, selective lymph node dissection (LND) based on metastatic pathways is increasingly common. The aim of this study was to evaluate the effectiveness of selective LND for cN0 lung cancer.

    Methods
    We retrospectively evaluated 1602 patients with previously untreated cN0 lung cancer resected with systematic LND between January 2001 and December 2012. We evaluated nodal metastatic patterns and frequency according to the primary location and pathology.

    Results
    Primary tumor locations were the right upper lobe (RUL) in 553, the right middle lobe (RML) in 110, the right lower lobe (RLL) in 343, the left upper lobe (LUL) in 364, and the left lower lobe (LLL) in 232. The tumor cell types were adenocarcinoma in 1272, squamous cell carcinoma in 228, large cell carcinoma in 50, adenosquamous cell carcinoma in 8 and others in 44. Among the patients with cN0 lung cancer who underwent operation, 8.1% had pN1 (129/1602) and 9.6% had pN2 (154/1602). In the cases of cN0 lung cancer, except cases of adenocarcinoma, the right and left upper lobe (RUL and LUL) tumors did not have subcarinal metastases and the right and left lower lobe tumors did not have superior mediastinal metastases. On the other hand, 4.2% of RUL and 2.8% LUL-superior segment cN0 adenocarcinoma had subcarinal metastases. The RUL and LUL-superior segment cN0 adenocarcinomas except 2 patients did not have subcarinal metastases when the superior mediastinal nodes were negative, whereas 7.7% of left lingular segment adenocarcinomas metastasized to subcarinal nodes even when the superior mediastinal nodes were negative. 3.1% of right and 3.3% of left basal segment cN0 adenocarcinomas had superior mediastinal metastases. The right and left basal segment cN0 adenocarcinomas did not have superior mediastinal metastases when the subcarinal nodes were negative, whereas 3.7% of right S6 and 5.6% of left S6 adenocarcinomas had metastatic superior mediastinal nodes even when the subcarinal nodes were negative. All the above-mentioned patients with lingular segment or right or left S6 adenocarcinoma had hilar lymph node metastases.

    Conclusion
    Lobe-specific selective LND is feasible for patients with cN0 lung cancer, except cases of adenocarcinoma. In cN0 RUL and LUL-superior segment adenocarcinomas, subcarinal dissection may be unnecessary if the superior mediastinal node is negative. In cN0 right and left basal segment adenocarcinomas, superior mediastinal dissection may be unnecessary if the subcarinal node is negative. On the other hand, as left lingular segment adenocarcinomas might metastasize to subcarinal nodes even if the superior mediastinal node is negative, and right and left S6 adenocarcinomas might metastasize to superior mediastinal nodes even if the subcarinal node is negative, selective LND requires confirmation of hilar LN-negative status.