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Characterization of Extracapsular Lymph Node Involvement and Its Clinicopathological Characteristics in Stage II–IIIA Lung Adenocarcinoma

  • Thoracic Oncology
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Abstract

Background

The prognostic impact and clinicopathological characteristics of extracapsular lymph node involvement (ECLNI) in patients with surgically resected lung adenocarcinoma (LUAD) remain unknown in the context of the eighth edition N classification.

Patients and Methods

We retrospectively reviewed 279 patients with stage II–IIIA LUAD who underwent lobectomy and lymphadenectomy. The correlations of ECLNI presence and clinicopathological profiles were analyzed. We also assessed the impact of ECLNI on the postoperative survival of pN1 and pN2 LUAD patients.

Results

ECLNI-positive status was more common in patients with high lymph node yield and in patients with multiple stations involved. The logistic regression model identified tumor spread through air spaces, micropapillary component, cribriform component, and nodal stage as predictive factors for ECLNI presence. LUAD patients with ECLNI presence had an increased risk of locoregional recurrence compared with those without (p < 0.001). Presence of ECLNI was confirmed as an independent risk factor for worse recurrence-free survival (RFS) (p < 0.001) and overall survival (OS) (p < 0.001) in the entire cohort. Among the 61 patients with ECLNI(+)pN2 disease, our analysis revealed that adjuvant radiation was a significant predictor of improved RFS and OS. In addition, ECLNI status provides additional precision in stratifying pN1 and pN2 patients with significantly different RFS and OS.

Conclusions

Our data suggest that ECLNI remains a strong prognosticator of unfavorable OS and RFS for LUADs in the context of the eighth edition N classification. Adjuvant radiation should be actively considered for pN1b and pN2 LUAD patients with ECLNI presence.

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Acknowledgement

We thank Dr. Feng Li from Second Affiliated Hospital of Soochow University for his kind help in reviewing the slides.

Funding

Supported by the projects from Shanghai Hospital Development Center (SHDC12015116), the National Natural Science Foundation of China (NSFC81770091), Clinical Research Foundation of Shanghai Pulmonary Hospital (FK1943, FK1936, FK1942, FK1941), Shanghai Municipal Health Commission (2018ZHYL0102, 2019SY072, 201940018), Science and Technology Commission of Shanghai Municipality (15411968400 and 14411962600), Suzhou Key Laboratory of Thoracic Oncology (SZS201907), Suzhou Key Discipline for Medicine (SZXK201803), and Municipal Program of People’s Livelihood Science and Technology in Suzhou (SS2019061), Jiangsu Key Research and Development Plan (Social Development) Project (BE2020653).

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Author notes

  1. Donglai Chen, Qifeng Ding, Wei Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China

    Donglai Chen MD & Chang Chen MD, PhD

  2. Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China

    Qifeng Ding MD, Wei Wang MD, Xiaofan Wang MD, Xuejie Wu MD & Yongbing Chen MD, PhD

  3. Department of Thoracic Surgery, Suzhou Kowloon Hospital Shanghai Jiaotong University School of Medicine, Suzhou, China

    Yiming Mao MD, PhD

  4. Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, China

    Yongsheng Zhang MD, PhD

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  1. Donglai Chen MD
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Correspondence to Chang Chen MD, PhD or Yongbing Chen MD, PhD.

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Cosenior authors: Chang Chen, Yongbing Chen and Yongsheng Zhang.

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Supplementary material 1 (DOCX 28 kb)

Supplementary Fig.

 1. Recurrence-free survival (a) and overall survival (b) in patients with a higher lymph node yield and those with a lower one (TIFF 2130 kb)

Supplementary Fig.

 2. Distribution of extracapsular nodal extension sites according to the primary tumor locations in intraoperatively surgical specimens (TIFF 116 kb)

Supplementary Fig.

 3. Cumulative incidence of locoregional recurrence (a) and distant recurrence (b) in the entire patient cohort with and without extracapsular nodal extension (TIFF 1986 kb)

Supplementary Fig.

 4 Cumulative incidence of locoregional recurrence and distant recurrence in pN1 (a, b) and pN2 (c, d) patients with and without extracapsular nodal extension (TIFF 441 kb)

Supplementary Fig.

 5 Kaplan–Meier curves of pN1 (a, b) and pN2 (c, d) patients with extracapsular nodal extension stratified by the median number of ECLNI-positive nodes (TIFF 5735 kb)

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Chen, D., Ding, Q., Wang, W. et al. Characterization of Extracapsular Lymph Node Involvement and Its Clinicopathological Characteristics in Stage II–IIIA Lung Adenocarcinoma. Ann Surg Oncol 28, 2088–2098 (2021). https://doi.org/10.1245/s10434-020-09154-6

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  • DOI: https://doi.org/10.1245/s10434-020-09154-6

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