Clinicopathological characteristics and lymph node metastasis pathway of non-small-cell lung cancer located in the left lingular division

Kazuhiko Shien, Shinichi Toyooka, Junichi Soh, Jiro Okami, Masahiko Higashiyama, Yoshihisa Kadota, Hajime Maeda, Makio Hayama, Masayuki Chida, Soichiro Funaki, Meinoshin Okumura, Shinichiro Miyoshi

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8 Citations (Scopus)

Abstract

OBJECTIVES The purpose of this study is to assess the clinicopathological characteristics of non-small-cell lung cancer (NSCLC) occurring in the left lingular division (LLD) in association with a proposal of the LLD-specific regional lymph node stations. METHODS Medical records of patients, who underwent complete tumour resection with mediastinal lymph node dissection (MLND) for LLD-NSCLC from 2000 to 2009 in multiple institutions, were retrospectively examined. We analysed patient clinicopathological characteristics and obtained the LLD-specific regional lymph node stations, and then the validity of intraoperative navigation in lymphadenectomy for LLD-NSCLC was investigated. RESULTS One hundred and eighty-four LLD-NSCLC patients (97 males and 87 females, and 128 adenocarcinomas and 56 non-adenocarcinomas) were studied. The 5-year overall survival (OS) and disease-free survival (DFS) rates for all LLD-NSCLC patients were 72.9 and 58.3%, respectively. We examined the lymph node metastasis patterns in 42 node-positive tumours. The frequent metastatic lymph node stations were #12u lobar node (n = 22), #5 subaortic node (n = 15) and #11 interlobar node (n = 13) in order. These three node stations were also single metastatic sites in some patients. Metastases to sub-carinal (#7) or inferior mediastinal nodes (#8) were rare. Thus, we assigned the three stations (#5, #11, #12u) as the regional lymph node stations for LLD-NSCLC. If these regional lymph node stations had been examined pathologically during surgery for a total of 160 LLD-NSCLC patients with c-T2N1M0 or lower stage disease, 125 p-N0 and 5 p-N1 patients diagnosed with no metastasis would have been subjected to selective MLND, while 14 p-N1 and all 16 p-N2 patients diagnosed with metastasis would have had complete MLND carried out. As a result, these regional lymph node stations could accurately predict the existence of p-N2 metastasis, and appropriately lead to a selective or complete MLND. CONCLUSIONS An intraoperative pathological examination using our proposed LLD-specific regional lymph node stations may accurately diagnose the status of node metastasis, and appropriately lead to selective or complete MLND in LLD-NSCLC patients with c-T2N1M0 or lower stage disease.

Original languageEnglish
Pages (from-to)791-796
Number of pages6
JournalInteractive cardiovascular and thoracic surgery
Volume20
Issue number6
DOIs
Publication statusPublished - Jun 1 2015

Keywords

  • Left lingular division
  • Lymph node metastasis
  • Non-small-cell lung cancer
  • Selective mediastinal lymph node dissection

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Shien, K., Toyooka, S., Soh, J., Okami, J., Higashiyama, M., Kadota, Y., Maeda, H., Hayama, M., Chida, M., Funaki, S., Okumura, M., & Miyoshi, S. (2015). Clinicopathological characteristics and lymph node metastasis pathway of non-small-cell lung cancer located in the left lingular division. Interactive cardiovascular and thoracic surgery, 20(6), 791-796. https://doi.org/10.1093/icvts/ivv062