Factors predicting lymph node metastasis in clinical stage T1aN0M0 lung adenocarcinomas

doi:10.3877/cma.j.issn.2095-8773.2015.01.006

Abstract

Abstract:

Objective

To determine the risk factors of lymph node metastasis in clinical stage T1aN0M0 lung adenocarcinomas.

Methods

Among a consecutive of 5312 patients with non-small lung cancer undergoing surgical resection at Shanghai Chest Hospital between January 2011 and December 2012, the clinical records of 273 patients with clinical stage T1aN0M0 lung adenocarcinomas were retrospectively analysed. Preoperative CT categorized the tumors of 273 patients as pure ground glass opacity(GGO), GGO with minimal solid components (diameter of solid part<5mm), part-solid (diameter of solid parts≥5mm) and pure solid. Relevant clinicopathologic features were investigated to identify the risk factors of lymph node metastasis using univariate and multivariate analysis.

Results

Thin-section CT was performed among all the 273 patients, among whom 103 (37.7%) were pure GGO, 118 (43.2%) GGO with minimal solid components(diameter of solid part<5 mm), 13 (4.8%) part-solid (diameter of solid parts≥5mm), and the other 39 (14.3%) pure solid. There were 18 (6.6%) patients with lymph node metastasis. The incidences of N₁ and N₂ nodal involvement were 6.5% (11 patients) and 4.1% (7 patients), respectively. No lymph node metastasis occurred in patients with pure GGO and GGO with minimal solid components (diameter of solid part<5mm). Multivariate analysis indicated that symptoms at presentation, diameter of solid parts≥5mm and increased carcinoembryonic antigen (CEA) titer were risk factors of lymph node metastasis of T1a lung adenocarcinomas. Multivariate analysis also revealed that air bronchogram sign, tumor size, symptoms at presentation and increased abnormal CEA titer were risk factors of lymph node metastasis of pure solid tumors (95%CI: 2.001-5.990, P=0.035; 95%CI: 1.000-3.980, P=0.021; 95%CI: 1.887-2.663, P=0.020; 95%CI: 1.514-8.498, P=0.013).

Conclusions

Lymph node dissection should not be performed among patients of clinical stage T1aN0M0 lung adenocarcinomas with GGO with minimal solid components (diameter of solid part<5 mm), or among pure GGO with no lymph node metastasis. However, systematic lymph node dissection should be performed for pure solid tumors or part-solid, especially in patients with CEA >5ng/ml or symptoms at presentation.

Key words: Lymph node, Lung adenocarcinomas, Carcinoma, non-small cell lung, Clinical stage

Bo Ye, Kejian Cao, Limin Fan, Jun Yang, Dingzhong Hu, Jianxin Shi, Zhigang Li, Wentao Fang, Heng Zhao, Haiquan Chen. Factors predicting lymph node metastasis in clinical stage T1aN0M0 lung adenocarcinomas[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2015, 02(01): 29-34.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxbwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8773.2015.01.006

https://zhxbwkdzzz.cma-cmc.com.cn/EN/Y2015/V02/I01/29

Figures/Tables 4

References 17

[1]	National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening[J]. N Engl J Med, 2011, 365(5)：395-409.
[2]	Rami-Porta R, Ball D, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer[J]. J Thorac Oncol, 2007, 2(7)：593-602.
[3]	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T₁ N₀ non-small cell lung cancer. Lung Cancer Study Group[J]. Ann Thorac Surg, 1995, 60(3): 615-622. discussion 622-623.
[4]	Noguchi M, Morikawa A, Kawasaki M, et al. Small adenocarcinoma of the lung. Histologic characteristics and prognosis[J]. Cancer, 1995, 75(12)：2844-2852.
[5]	Suzuki K, Yokose T, Yoshida J, et al. Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung[J]. Ann Thorac Surg, 2000, 69(3)：893-897.
[6]	Suzuki K, Asamura H, Kusumoto M, et al. "Early" peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan[J]. Ann Thorac Surg, 2002, 74(5)：1635-1639.
[7]	Suzuki K, Kusumoto M, Watanabe S, et al. Radiologic classification of small adenocarcinoma of the lung: radiologic-pathologic correlation and its prognostic impact[J]. Ann Thorac Surg, 2006, 81(2)：413-419.
[8]	Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201) [J]. J Thorac Oncol, 2011, 6(4)：751-756.
[9]	Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system[J]. Chest, 2009, 136(1)：260-271.
[10]	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society: international multidisciplinary classification of lung adenocarcinoma: executive summary[J]. Proc Am Thorac Soc, 2011, 8(5)：381-385.
[11]	Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial[J]. Ann Thorac Surg, 2006, 81(3)：1013-1019, discussion 1019-1020.
[12]	Watanabe S, Oda M, Go T, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2cm or less) lung cancer? Retrospective analysis of 225 patients[J]. Eur J Cardiothorac Surg, 2001, 20(5)：1007-1011.
[13]	Fukui T, Katayama T, Ito S, et al. Clinicopathological features of small-sized non-small cell lung cancer with mediastinal lymph node metastasis[J]. Lung Cancer, 2009, 66(3)：309-313.
[14]	Hattori A, Suzuki K, Matsunaga T, et al. Is limited resection appropriate for radiologically "solid" tumors in small lung cancers? [J] Ann Thorac Surg, 2012, 94(1)：212-215.
[15]	Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival? A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification[J]. J Thorac Oncol，2011, 6(9)：1496-1504.
[16]	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L) [J]. Jpn J Clin Oncol, 2010, 40(3)：271-274.
[17]	Altorki NK, Pass HI, Miller DL, et al. Comparison of different types of surgery in treating patients with stage IA non-small cell lung cancer, ClinicalTrials.gov identifier: NCT00499330[DB/OL]．Bethesda，MD：Clinical Trials Gov，2013. URL

变量			例数	临床分期			χ ²/F值	P值
变量			例数	pN0(255例)	pN1(11例)	pN2(7例)	χ ²/F值	P值
年龄			?	?	?	?	0.631	0.643
?	≤59岁		112	103	6	3	?	?
?	>59岁		161	152	5	4	?	?
性别			?	?	?	?	2.142	0.857
?	女性		145	136	5	4	?	?
?	男性		128	119	6	3	?	?
吸烟史			?	?	?	?	0.231	0.916
?	无		164	154	6	4	?	?
?	有		109	101	5	3	?	?
症状			?	?	?	?	0.645	0.001
?	无		228	218	5	5	?	?
?	有		45	37	6	2	?	?
肿瘤直径			?	?	?	?	9.081	0.854
?	<1.0cm		59	56	2	1	?	?
?	1.0～2.0cm		214	199	9	6	?	?
小结节的影像学表现			?	?	?	?	22.51^*	0.000
?	纯GGO		103	103	0	0	?	?
?	GGO带有实性成分(直径<5mm)		118	118	0	0	?	?
?	部分实性结节(直径≥5mm)		?	?	?	?	?	?
?	?	GGO为主	5	5	0	0	?	?
?	?	实性为主	8	6	1	1	?	?
?	?	纯实性	39	23	10	6	?	?
胸膜凹陷			?	?	?	?	0.93	0.024
?	无		183	176	5	2	?	?
?	有		90	79	6	5	?	?
空气支气管征			?	?	?	?	2.653	0.546
?	无		157	147	5	5	?	?
?	有		116	108	6	2	?	?
CEA水平			?	?	?	?	14.43	0.000
?	≤5ng/ml		209	204	3	2	?	?
?	>5ng/ml		64	51	8	5	?	?
病理类型			?	?	?	?	16.34^*	0.000
?	AAH		20	20	0	0	?	?
?	AIS		78	78	0	0	?	?
?	MIA		133	133	0	0	?	?
?	IA		42	24	10	8	?	?

变量			例数	临床分期			χ ²/F值	P值
变量			例数	pN0(255例)	pN1(11例)	pN2(7例)	χ ²/F值	P值
年龄			?	?	?	?	0.631	0.643
?	≤59岁		112	103	6	3	?	?
?	>59岁		161	152	5	4	?	?
性别			?	?	?	?	2.142	0.857
?	女性		145	136	5	4	?	?
?	男性		128	119	6	3	?	?
吸烟史			?	?	?	?	0.231	0.916
?	无		164	154	6	4	?	?
?	有		109	101	5	3	?	?
症状			?	?	?	?	0.645	0.001
?	无		228	218	5	5	?	?
?	有		45	37	6	2	?	?
肿瘤直径			?	?	?	?	9.081	0.854
?	<1.0cm		59	56	2	1	?	?
?	1.0～2.0cm		214	199	9	6	?	?
小结节的影像学表现			?	?	?	?	22.51^*	0.000
?	纯GGO		103	103	0	0	?	?
?	GGO带有实性成分(直径<5mm)		118	118	0	0	?	?
?	部分实性结节(直径≥5mm)		?	?	?	?	?	?
?	?	GGO为主	5	5	0	0	?	?
?	?	实性为主	8	6	1	1	?	?
?	?	纯实性	39	23	10	6	?	?
胸膜凹陷			?	?	?	?	0.93	0.024
?	无		183	176	5	2	?	?
?	有		90	79	6	5	?	?
空气支气管征			?	?	?	?	2.653	0.546
?	无		157	147	5	5	?	?
?	有		116	108	6	2	?	?
CEA水平			?	?	?	?	14.43	0.000
?	≤5ng/ml		209	204	3	2	?	?
?	>5ng/ml		64	51	8	5	?	?
病理类型			?	?	?	?	16.34^*	0.000
?	AAH		20	20	0	0	?	?
?	AIS		78	78	0	0	?	?
?	MIA		133	133	0	0	?	?
?	IA		42	24	10	8	?	?

外科病理学特征		纯GGO组	混合性GGO组	纯实性组	χ²/F值	P值
手术方式		?	?	?	27.553	0.000
?	肺段切除	40	34	2	?	?
?	肺叶切除	63	97	37	?	?
淋巴结转移		?	?	?	21.332^*	0.000
?	N0	103	129	23	?	?
?	N1	0	1	10	?	?
?	N2	0	1	6	?	?
病理学类型		?	?	?	103.211^*	0.000
?	AAH	20	0	0	?	?
?	AIS	78	0	0	?	?
?	MIA	5	127	1	?	?
?	IA	0	4	38	?	?

外科病理学特征		纯GGO组	混合性GGO组	纯实性组	χ²/F值	P值
手术方式		?	?	?	27.553	0.000
?	肺段切除	40	34	2	?	?
?	肺叶切除	63	97	37	?	?
淋巴结转移		?	?	?	21.332^*	0.000
?	N0	103	129	23	?	?
?	N1	0	1	10	?	?
?	N2	0	1	6	?	?
病理学类型		?	?	?	103.211^*	0.000
?	AAH	20	0	0	?	?
?	AIS	78	0	0	?	?
?	MIA	5	127	1	?	?
?	IA	0	4	38	?	?

变量	OR	HR(95% CI)	P值
GGO状态	44.212	7.901～247.39	0.000
症状	6.501	1.179～35.84	0.032
CEA	7.854	1.486～41.524	0.015

Please choose a citation manager

Content to export