Clinicopathologic predictors of metastasis of different regional lymph nodes in patients intraoperatively diagnosed with stage-I non-small cell lung cancer

• Published in: BMC cancer 2019-05, Vol.19 (1), p.444-444, Article 444
• Main Authors: Zhao, Fei, Zhen, Fu-Xi, Zhou, Yue, Huang, Chen-Jun, Yu, Yue, Li, Jun, Li, Qi-Fan, Zhu, Cheng-Xiang, Yang, Xiao-Yu, You, Shu-Hui, Wu, Qian-Ge, Qin, Xue-Yun, Liu, Yi, Chen, Liang, Wang, Wei
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Albumin; Biopsy; Cancer metastasis; Carcinoembryonic antigen; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Care and treatment; Cartilage; Diagnosis; Dissection; Female; Humans; Lobectomy; Logistic Models; Logistic regression; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision; Lymph nodes; Lymphatic Metastasis - pathology; Lymphatic system; Male; Medical imaging; Metastases; Metastasis; Middle Aged; Mucosa; Multivariable logistic regression; Neoplasm Staging; Non-small cell lung cancer; Non-small cell lung carcinoma; Ostomy; Patients; Pulmonary Surgical Procedures; Regional lymph node; Regionalism; Regression analysis; Retrospective Studies; Small cell lung cancer; Small cell lung carcinoma; Surgeons; Surgery; Thoracic surgery; Tuberculosis; Tumors
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-019-5632-2

Selection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Here, we sought to identify the clinicopathologic predictors of regional lymph node metastasis in patients intraoperatively diagnosed with stage-I NSCLC. A retrospective review of 595 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection was performed. Univariate and multivariable logistic regression analysis was performed to determine the independent predictors of regional lymph node metastasis. Univariate logistic regression and multivariable analysis revealed three independent predictors of the presence of metastatic hilar lymph nodes, five independent predictors for lobe specific mediastinal lymph nodes, two independent predictors for lobe nonspecific mediastinal lymph nodes and two independent predictors for skipping mediastinal lymph nodes. A complete mediastinal lymph node dissection may be considered for patients suspected of nerve invasion and albumin (> 43.1 g/L) or nerve and vascular invasions. Lobe-specific lymph node dissection should probably be performed for patients suspected of pulmonary membrane invasion, vascular invasion, CEA (> 2.21 ng/mL), and tumor (> 1.6 cm) in the right lower lobe or mixed lobes. Hilar lymph node dissection should probably be performed for patients suspected of having bronchial mucosa and cartilage invasion, vascular invasion, and CEA (> 2.21 ng/mL).