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Systematic Versus Lobe-Specific Mediastinal Lymphadenectomy for Hypermetabolic Lung Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal extent of lymph node dissection (LND) for hypermetabolic tumors that are associated with high rates of nodal disease, recurrence, or mortality has not been elucidated.

Methods

We reviewed 375 patients who underwent lobectomy with lymphadenectomy for clinical T2–3 N0–1 M0 hypermetabolic non-small cell lung cancer (NSCLC) [maximum standard uptake value (SUVmax) ≥ 6.60] via a multicenter database. Extent of LND was classified into systematic mediastinal LND (systematic LND) and lobe-specific mediastinal LND (lobe-specific LND). Postoperative outcomes after lobectomy with systematic LND (n = 128) and lobe-specific LND (n = 247) were analyzed for all patients and their propensity-score-matched pairs.

Results

Cancer-specific survival (CSS) and recurrence-free interval (RFI) of the systematic LND group were not significantly different from those of the lobe-specific LND group in the nonadjusted whole cohort. In the propensity-score-matched cohort (101 pairs), systematic LND dissected significantly more lymph nodes (20.0 versus 16.0 nodes, P = 0.0057) and detected lymph node metastasis more frequently (53.5% vs. 33.7%, P = 0.0069). Six (5.9%) patients in the systematic LND group had a metastatic N2 lymph node “in the systematic LND field” that lobe-specific LND could not dissect. The systematic LND group tended to have better prognosis than the lobe-specific LND group (5-year CSS rates, 82.6% versus 69.6%; 5-year RFI rates, 56.6% vs. 47.3%).

Conclusions

Systematic LND was found to harvest more metastatic lymph nodes and provide better oncological outcome than lobe-specific LND in a cohort of hypermetabolic NSCLC patients.

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Abbreviations

LND:

Lymph node dissection

NSCLC:

Non-small cell lung cancer

SUVmax:

Maximum standard uptake value

HRCT:

High-resolution computed tomography

FDG-PET:

18F-fluorodeoxyglucose positron emission tomography

C/T ratio:

Consolidation tumor ratio

IQR:

Interquartile range

CSS:

Cancer-specific survival

RFI:

Recurrence-free interval

ROC:

Receiver operating characteristic

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Acknowledgment

Handa, Tsutani, Mimae, and Miyata designed this study. Ito, Shimada, Nakayama, Ikeda, and Okada supervised the study. Handa, Tsutani, Mimae, and Miyata collected clinical information. Handa, Tsutani, Mimae, and Miyata analyzed and interpreted all of the data. All authors wrote the manuscript.

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Authors and Affiliations

  1. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Yoshinori Handa MD, PhD, Yasuhiro Tsutani MD, PhD, Takahiro Mimae MD, PhD, Yoshihiro Miyata MD, PhD & Morihito Okada MD, PhD

  2. Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan

    Hiroyuki Ito MD, PhD & Haruhiko Nakayama MD, PhD

  3. Department of Surgery, Tokyo Medical University, Tokyo, Japan

    Yoshihisa Shimada MD, PhD & Norihiko Ikeda MD, PhD

Authors
  1. Yoshinori Handa MD, PhD
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  2. Yasuhiro Tsutani MD, PhD
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  3. Takahiro Mimae MD, PhD
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  4. Yoshihiro Miyata MD, PhD
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  5. Hiroyuki Ito MD, PhD
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  6. Yoshihisa Shimada MD, PhD
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  7. Haruhiko Nakayama MD, PhD
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  8. Norihiko Ikeda MD, PhD
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  9. Morihito Okada MD, PhD
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Corresponding author

Correspondence to Morihito Okada MD, PhD.

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Supplementary Information

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10434_2021_10020_MOESM1_ESM.tif

Fig. S1. Receiver operating characteristic (ROC) curve (area under the curve: 0.78; P < 0.0001). The cutoff for maximum standard uptake value with the best combined sensitivity and specificity was 6.60 (TIF 197 kb)

Supplementary material 2 (DOCX 54 kb)

Supplementary material 3 (DOCX 47 kb)

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Handa, Y., Tsutani, Y., Mimae, T. et al. Systematic Versus Lobe-Specific Mediastinal Lymphadenectomy for Hypermetabolic Lung Cancer. Ann Surg Oncol 28, 7162–7171 (2021). https://doi.org/10.1245/s10434-021-10020-2

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  • DOI: https://doi.org/10.1245/s10434-021-10020-2

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