Predictive risk factors for lymph node metastasis in patients with resected non-small cell lung cancer: a case control study

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Abstract

Background

Estimation of lymph node status is essential in order to determine precise therapy for patients with non-small cell lung cancer (NSCLC). Furthermore, lymph node involvement is a very powerful prognostic factor in these patients. In this analysis, we aim to evaluate the predictive factors for lymph node metastasis in NSCLC-patients.

Methods

In a prospectively-established database, we analyzed all data of patients with NSCLC, who underwent oncological surgical resections from 01/2007 to 12/2016, retrospectively. The correlation between clinicopathological parameters and lymph node metastasis was investigated by using univariate and binary logistic regression analysis.

Results

In this study, we operated on 204 consecutive patients, 142 men (71.7%) and 56 women (28.3%). Lymph node metastases were detected in 38.2% (78/204). Preoperatively, central tumor localization (OR = 2.6, 95% CI = 1.3–5.1, P = 0.005) and tumor size > 3 cm (OR = 2.5, 95% CI = 1.3–4.4, P = 0.005) were found to be significant predictive factors for lymph node metastasis. Postoperatively, multivariate analysis showed that intratumoral lymph vessel invasion (L1-status) (OR = 17.3, 95% CI = 5.1–58.4, P < 0.001) along with the central tumor localization (OR = 2.8, 95% CI = 1.4–5.8, P = 0.004) were significantly associated with lymph node metastasis. In small size tumors (≤3 cm), two predictive factors for lymph node metastasis were found: central tumor localization (OR = 19.4, 95% = 2.1–186.4, P = 0.01) and L1-status (OR = 43.9, 95% CI = 3.6–529.4, P = 0.003).

Conclusions

A precise pre- and intraoperative assessment of the lymph node status is essential in patients with larger sized tumors and central localization. Furthermore, L1-status is a highly significant risk factor for lymph node metastasis in NSCLC-Patients. Therefore, an adjuvant therapy in patients with L1-status and pNX category should be considered.

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Most cited references 21

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Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer.

Paul De Leyn, Christophe Dooms, Jaroslaw Kuzdzal … (2014)

Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours ≤ 3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours >3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study.

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Regional lymph node classification for lung cancer staging.

C F Mountain, C M Dresler (1997)

Recommendations for classifying regional lymph node stations for lung cancer staging have been adopted by the American Joint Committee on Cancer (AJCC) and the Union Internationale Contre le Cancer. The objective was to unify the two systems that have been in common use for the past 10 years; that is, the schema advocated by the AJCC, adapted from the work of Tsuguo Naruke, and the schema advocated by the American Thoracic Society and the North American Lung Cancer Study Group. Anatomic landmarks for 14 hilar, intrapulmonary, and mediastinal lymph node stations are designated. This classification provides for consistent, reproducible, lymph node mapping that is compatible with the international staging system for lung cancer. It is applicable for clinical and surgical-pathologic staging.

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Metastases from non-small cell lung cancer: mediastinal staging in the 1990s--meta-analytic comparison of PET and CT.

B A Dwamena, S S Sonnad, J O Angobaldo … (1999)

To meta-analytically compare 2-[fluorine 18]fluoro-2-deoxy-D-glucose positron emission tomography (PET) and computed tomography (CT) for the demonstration of mediastinal nodal metastases in patients with non-small cell lung cancer. English-language reports on the diagnostic performance of PET (14 studies, 514 patients) and/or CT (29 studies, 2,226 patients) for demonstration of mediastinal nodal metastases from NSCLC were selected by using the MEDLINE database. In eligible studies, an objective diagnostic standard was used, data were presented to allow recalculation of contingency tables, and established diagnostic criteria were used for abnormal test results. Summary receiver operating characteristic (ROC) curves were calculated. Pooled point estimates of diagnostic performance and summary ROC curves indicated that PET was significantly more accurate than CT for demonstration of nodal metastases (P < .001). Mean sensitivity and specificity (+/- 95% CI) were 0.79 +/- 0.03 and 0.91 +/- 0.02, respectively, for PET and 0.60 +/- 0.02 and 0.77 +/- 0.02, respectively, for CT. The log odds ratios were 1.79 (95% CI: 1.49, 2.09) for CT and 3.77 (95% CI: 2.77, 4.77) for PET (P < .001). Subgroup analyses did not alter findings. PET is superior to CT for mediastinal staging of non-small cell lung cancer, independent of performance index or clinical context of PET imaging.

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Author and article information

Contributors

Yusef Moulla:

ORCID: http://orcid.org/0000-0002-5936-0217

0049341-9717200 , yusef.moulla@medizin.uni-leipzig.de

Tanja Gradistanac: tanja.gradistanac@medizin.uni-leipzig.de

Christian Wittekind: christian.wittekind@medizin.uni-leipzig.de

Uwe Eichfeld: uwe.eichfeld@medizin.uni-leipzig.de

Ines Gockel: ines.gockel@medizin.uni-leipzig.de

Arne Dietrich: arne.dietrich@medizin.uni-lipzig.de

Journal

Journal ID (nlm-ta): J Cardiothorac Surg

Journal ID (iso-abbrev): J Cardiothorac Surg

Title: Journal of Cardiothoracic Surgery

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-8090

Publication date (Electronic): 16 January 2019

Publication date PMC-release: 16 January 2019

Publication date Collection: 2019

Volume: 14

Electronic Location Identifier: 11

Affiliations

[1 ]ISNI 0000 0000 8517 9062, GRID grid.411339.d, Department of Visceral, Transplant, Thoracic and Vascular Surgery, , University Hospital of Leipzig, ; Liebigstraße 20, 04103 Leipzig, Germany

[2 ]ISNI 0000 0000 8517 9062, GRID grid.411339.d, Institute of Pathology, , University Hospital of Leipzig, ; Liebigstraße 20, 04103 Leipzig, Germany

Author information

Yusef Moulla http://orcid.org/0000-0002-5936-0217

Article

Publisher ID: 831

DOI: 10.1186/s13019-019-0831-0

PMC ID: 6335711

PubMed ID: 30651112

SO-VID: fcee9957-b6a7-4993-8ce6-42f23430f387

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 19 May 2018

Date accepted : 8 January 2019

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ScienceOpen disciplines: Surgery

Keywords: non-small cell lung cancer (nsclc),lymph node metastasis,lymphatic vessel invasion

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ScienceOpen disciplines: Surgery

Keywords: non-small cell lung cancer (nsclc), lymph node metastasis, lymphatic vessel invasion

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Predictive risk factors for lymph node metastasis in patients with resected non-small cell lung cancer: a case control study

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Abstract

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25th European Students' Conference

Most cited references 21

Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer.

Regional lymph node classification for lung cancer staging.

Metastases from non-small cell lung cancer: mediastinal staging in the 1990s--meta-analytic comparison of PET and CT.

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