LOBE-SPECIFIC METASTASIS IN NON-SMALL CELL LUNG CANCER
https://doi.org/10.21294/1814-4861-2021-20-5-31-40
Abstract
Aim: to identify the pathways of lymph node metastases in non-small cell lung cancer (NSCLC).
Material and Methods. The frequency of mediastinal lymph node metastases and treatment outcomes were analyzed in 327 patients with stage I–III non-small cell lung carcinoma (NSCLC), who underwent lung resection with systematic lymph node dissection (SLND) between 2007 and 2011.
Results. In cases with tumor location in any lobe of the right lung, metastasis occurred in the superior and inferior mediastinal lymph nodes. In left-side tumors, the main pathways of lymphatic spread of tumors were superior and inferior mediastinal nodes as well as aortic lymph nodes. Left lower lobe tumors metastasized most often to inferior mediastinal lymph nodes. Skip metastases were observed at any location of the tumor. Routine examination of all ipsilateral mediastinal lymph nodes overstaged NSCLC in 19.5 % of cases. The overall 5-and 10-year survival rates in patients with stage I–III NSCLC with SND were 61.5 % and 49.2 %, respectively. The median survival time was 103 months.
Conclusion. Despite typical metastatic patterns of mediastinal lymph nodes in patients with NSCLC, non-specific metastasis was observed at any location of the tumor, which required mandatory systematic nodal dissection.
About the Authors
A. A. Aksarin
Surgut District Clinical Hospital
Russian Federation
Russian Federation
MD, PhD, Head of the Oncology Center, Regional Oncology Dispensary,
24, Energetikov Street, 628408, Surgut
M. D. Ter-Ovanesov
State Medical Institution Hospital No. 40;
RUDN University
Russian Federation
Russian Federation
MD, DSc, Professor, Deputy Head Physician for Medical Care (Organization of Surgical and Oncological
Care), Moscow;
Head of the Department of Oncology and Hematology, Faculty of Advanced Medical Education, 6, Miklukho-Maklaya Street, 117198, Moscow
A. A. Mordovsky
Surgut District Clinical Hospital
Russian Federation
Russian Federation
MD, Oncologist, Regional Oncology Dispensary,
24, Energetikov Street, 628408, Surgut
S. M. Kopeyka
Surgut District Clinical Hospital
Russian Federation
Russian Federation
MD, Head of the Department of the Oncology Center, Regional Oncology Dispensary,
24, Energetikov Street, 628408, Surgut
P. P. Troyan
Surgut District Clinical Hospital
Russian Federation
Russian Federation
MD, Head of the Department of the Oncology Center, Regional Oncology Dispensary,
24, Energetikov Street, 628408, Surgut
References
1. Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov; 68(6): 394–424. doi: 10.3322/caac.21492.
2. Mordovskii A.A., Aksarin A.A. The morbidity of lung cancer in the population of the KhantyMansiysk autonomous district-Ugra. Siberian Medical Review. 2015; 20(2): 85–8. (in Russian). doi: 10.20333/25000136-2015-2-85-88.
3. Stilidi I.S., Ter-Ovanesov M.D. Surgical treatment of lung cancer. Practical Oncology. 2000; 3: 21–3. (in Russian).
4. Martini N., Flehinger B.J. The role of surgery in N2 lung cancer. Surg Clin North Am. 1987 Oct; 67(5): 1037–49. doi: 10.1016/s0039-6109(16)44341-0.
5. Gaer J.A., Goldstraw P. Intraoperative assessment of nodal staging at thoracotomy for carcinoma of the bronchus. Eur J Cardiothorac Surg. 1990; 4(4): 207–10. doi: 10.1016/1010-7940(90)90006-l.
6. Goldstraw P. The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer. Thorax; 1992; 47: 1–2.
7. Goldstraw P., Mannam G.C., Kaplan D.K., Michail P. Surgical management of non-small-cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease). J Thorac Cardiovasc Surg. 1994 Jan; 107(1): 19–27; discussion 27-8.
8. Goldstraw P. Report on the international workshop on intrathoracic staging. London, October 1996. Lung Cancer. 1997; 18: 107–111.
9. Ishiguro F., Matsuo K., Fukui T., Mori S., Hatooka S., Mitsudomi T. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable nonsmall cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg. 2010; 139(4): 1001–6. doi: 10.1016/j.jtcvs.2009.07.024.
10. Allen M.S., Darling G.E., Pechet T.T., Mitchell J.D., Herndon J.E. 2nd, Landreneau R.J., Inculet R.I., Jones D.R., Meyers B.F., Harpole D.H., Putnam J.B.Jr., Rusch V.W.; ACOSOG Z0030 Study Group. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006; 81(3): 1013–9. doi: 10.1016/j.athoracsur.2005.06.066.
11. Van Schil P.E. Action point: intraoperative lymph node staging. Eur J Cardiothorac Surg. 2012 Apr; 41(4): 839–40. doi: 10.1093/ejcts/ezr061.
12. Riquet M., Rivera C., Pricopi C., Arame A., Mordant P., Foucault C., Dujon A., Le Pimpec-Barthes F. Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal. Eur J Cardiothorac Surg. 2015 Mar; 47(3): 543–9. doi: 10.1093/ejcts/ezu226.
13. Travis W.D., Giroux D.J., Chansky K., Crowley J., Asamura H., Brambilla E., Jett J., Kennedy C., Rami-Porta R., Rusch V.W., Goldstraw P.; International Staging Committee and Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the inclusion of broncho-pulmonary carcinoid tumors in the forthcoming (seventh) edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2008 Nov; 3(11): 1213–23. doi: 10.1097/JTO.0b013e31818b06e3.
14. Ziyade S., Pinarbasili N.B., Ziyade N., Akdemir O.C., Sahin F., Soysal Ö., Toker A. Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery. J Cardiothorac Surg. 2013 Apr 16; 8: 94. doi: 10.1186/1749-8090-8-94.
15. Lardinois D., Weder W., Hany T.F., Kamel E.M., Korom S., Seifert B., von Schulthess G.K., Steinert H.C. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003 Jun 19; 348(25): 2500–7. doi: 10.1056/NEJMoa022136.
16. Asamura H., Nakayama H., Kondo H., Tsuchiya R., Naruke T. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg. 1999 Jun; 117(6): 1102–11. doi: 10.1016/s0022-5223(99)70246-1.
17. Mun M., Nakao M., Matsuura Y., Ichinose J., Okumura S. Oncological outcomes after lobe-specific mediastinal lymph node dissection via multiport video-assisted thoracoscopic surgery. Eur J Cardiothorac Surg. 2020 Aug 1; 58(Suppl_1): i92–i99. doi: 10.1093/ejcts/ezaa166.
Review
For citations:
Aksarin A.A., Ter-Ovanesov M.D., Mordovsky A.A., Kopeyka S.M., Troyan P.P. LOBE-SPECIFIC METASTASIS IN NON-SMALL CELL LUNG CANCER. Siberian journal of oncology. 2021;20(5):31-40. (In Russ.) https://doi.org/10.21294/1814-4861-2021-20-5-31-40
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