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Metastatic pathways to the lower zone by segment in patients with clinical T1 lower lobe non-small cell lung cancer

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Abstract

Objective

Segmentectomy and mediastinal lymph node dissection (LND) may increasingly be used for non-small cell lung cancer (NSCLC). Lymph node metastasis (LNM) distribution varies by lower lobe segments; however, its segment-specific spread to the lower zone (#8, 9) (LZ) in lower lobe NSCLC is seldom reported.

Methods

In total, 352 patients with clinical T1 lower lobe NSCLC who underwent lobectomy with systematic or lobe-specific LND were included for analysis between January 2006 and December 2018.

Results

Fifty-eight (16.2%) patients had LNM (pN1: 24, pN2: 34), and nine (2.6%) had LZ metastasis. LZ metastasis was significantly more frequent in tumors with diameter > 2 cm, tumors without ground-glass opacity on radiological findings, left lung cancer, and basal segment lung cancer (respectively, p = 0.039, 0.006, 0.0177, 0.0024). None of the S6 NSCLC patients had LZ metastasis. Two patients with right basal segment NSCLC had LZ metastases (tumor on S10) as well as N1 lymph node and subcarinal zone metastasis. Seven (8.4%) patients with left basal segment NSCLC had LZ metastasis (tumor on S8: 3, tumor on S10: 4). Of them, three patients with left basal NSCLC had isolated LZ metastasis.

Conclusions

The LND of the LZ can be omitted for clinical T1 patients with S6 NSCLC. In addition, the LND of the LZ may be omitted in right basal NSCLC if intraoperative confirmation of negative N1 and subcarinal zone lymph nodes is obtained; however, it is necessary for left basal segment NSCLC.

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Data availability

The data that support the findings of this study are available from the corresponding author, TM, upon reasonable request.

References

  1. Cahan WG. Radical lobectomy. J Thorac Cardiovasc Surg. 1960;39:555–72. https://doi.org/10.1016/S0022-5223(20)31797-9.

    Article  CAS  PubMed  Google Scholar 

  2. Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399:1607–17. https://doi.org/10.1016/S0140-6736(21)02333-3.

    Article  CAS  PubMed  Google Scholar 

  3. Watanabe S, Suzuki K, Asamura H. Superior and basal segment lung cancers in the lower lobe have different lymph node metastatic pathways and prognosis. Ann Thorac Surg. 2008;85:1026–31. https://doi.org/10.1016/j.athoracsur.2007.10.076.

    Article  PubMed  Google Scholar 

  4. Tomizawa K, Suda K, Takemoto T, Mizuno T, Kuroda H, Sakakura N, et al. Prognosis and segment-specific nodal spread of primary lung cancer in the right lower lobe. Thorac Cancer. 2015;6:672–7. https://doi.org/10.1111/1759-7714.12235.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Handa Y, Tsutani Y, Tsubokawa N, Misumi K, Hanaki H, Miyata Y, et al. Clinical prognosis of superior versus basal segment Stage I non-small cell lung cancer. Ann Thorac Surg. 2017;104:1896–901. https://doi.org/10.1016/j.athoracsur.2017.06.060.

    Article  PubMed  Google Scholar 

  6. Okada M, Sakamoto T, Yuki T, Mimura T, Nitanda H, Miyoshi K, et al. Border between N1 and N2 stations in lung carcinoma: lessons from lymph node metastatic patterns of lower lobe tumors. J Thorac Cardiovasc Surg. 2005;129:825–30. https://doi.org/10.1016/j.jtcvs.2004.06.016.

    Article  PubMed  Google Scholar 

  7. Ueno H, Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Is lower zone mediastinal nodal dissection always mandatory for lung cancer in the lower lobe? Surg Today. 2015;45:1390–5. https://doi.org/10.1007/s00595-014-1105-z.

    Article  PubMed  Google Scholar 

  8. Hishida T, Saji H, Watanabe SI, Asamura H, Aokage K, Mizutani T, et al. A randomized Phase III trial of lobe-specific vs. systematic nodal dissection for clinical Stage I-II non-small cell lung cancer (JCOG1413). Jpn J Clin Oncol. 2018;48:190–4. https://doi.org/10.1093/jjco/hyx170.

    Article  PubMed  Google Scholar 

  9. Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P, et al. (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 4:568–77. https://doi.org/10.1097/JTO.0b013e3181a0d82e

  10. Travis WD, Brambilla E, Ap Marx B, Nicholson A (2015) AG International Agency for Research on Cancer. WHO classification of tumours of the lung, pleura, Thymus and Heart. Lyon: International Agency for Research on Cancer

  11. Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJ, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26:3552–9. https://doi.org/10.1200/JCO.2007.13.9030.

    Article  PubMed  Google Scholar 

  12. Tsuboi M, Herbst RS, John T, Kato T, Majem M, Grohé C, et al. Overall survival with osimertinib in resected EGFR-mutated NSCLC. N Engl J Med. 2023;389:137–47. https://doi.org/10.1056/NEJMoa2304594.

    Article  CAS  PubMed  Google Scholar 

  13. Felip E, Altorki N, Zhou C, Csőszi T, Vynnychenko I, Goloborodko O, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial. Lancet. 2021;398:1344–57. https://doi.org/10.1016/S0140-6736(21)02098-5.

    Article  CAS  PubMed  Google Scholar 

  14. Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141:662–70. https://doi.org/10.1016/j.jtcvs.2010.11.008.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mokhles S, Macbeth F, Treasure T, Younes RN, Rintoul RC, Fiorentino F, et al. Systematic lymphadenectomy versus sampling of ipsilateral mediastinal lymph-nodes during lobectomy for non-small-cell lung cancer: a systematic review of randomized trials and a meta-analysis. Eur J Cardiothorac Surg. 2017;51:1149–56. https://doi.org/10.1093/ejcts/ezw439.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sano Y, Shigematsu H, Okazaki M, Sakao N, Mori Y, Yukumi S, et al. Hoarseness after radical surgery with systematic lymph node dissection for primary lung cancer. Eur J Cardiothorac Surg. 2019;55:280–5. https://doi.org/10.1093/ejcts/ezy246.

    Article  PubMed  Google Scholar 

  17. Kutlu CA, Sayar A, Olgac G, Akin H, Olcmen A, Bedirhan MA, et al. Chylothorax: a complication following lung resection in patients with NSCLC – chylothorax following lung resection. Thorac Cardiovasc Surg. 2003;51:342–5. https://doi.org/10.1055/s-2003-45423.

    Article  CAS  PubMed  Google Scholar 

  18. Imai K, Minamiya Y, Saito H, Nakagawa T, Ito M, Ono T, et al. Detection of pleural lymph flow using indocyanine green fluorescence imaging in non-small cell lung cancer surgery: a preliminary study. Surg Today. 2013;43:249–54. https://doi.org/10.1007/s00595-012-0237-2.

    Article  PubMed  Google Scholar 

  19. Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Prognostic impact of a ground glass opacity component in the clinical T classification of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2017;154:2102-2110.e1. https://doi.org/10.1016/j.jtcvs.2017.08.037.

    Article  PubMed  Google Scholar 

  20. Maniwa T, Okami J, Miyoshi T, Wakabayashi M, Yoshioka H, Mimae T, et al. Lymph node dissection in small peripheral lung cancer: supplemental analysis of JCOG0802/WJOG4607L. J Thorac Cardiovasc Surg. 2023. https://doi.org/10.1016/j.jtcvs.2023.11.023.

    Article  PubMed  Google Scholar 

  21. Maniwa T, Okumura T, Isaka M, Nakagawa K, Ohde Y, Kondo H. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2013;44:e59-64. https://doi.org/10.1093/ejcts/ezt195.

    Article  PubMed  Google Scholar 

  22. Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D, et al. Lobar or sublobar resection for peripheral stage IA non-small-cell lung cancer. N Engl J Med. 2023;388:489–98. https://doi.org/10.1056/NEJMoa2212083.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan

    Tomohiro Maniwa, Ryu Kanzaki & Jiro Okami

  2. Department of Oncology, Graduate School of Medicine, Osaka University, Osaka, Japan

    Tomohiro Maniwa & Masayuki Ohue

  3. Department of General Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Yasushi Shintani

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  1. Tomohiro Maniwa
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  2. Masayuki Ohue
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Correspondence to Tomohiro Maniwa.

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Maniwa, T., Ohue, M., Kanzaki, R. et al. Metastatic pathways to the lower zone by segment in patients with clinical T1 lower lobe non-small cell lung cancer. Gen Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s11748-024-02021-1

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