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Lymph node metastasis and prognosis in small peripheral non-small-cell lung cancers
K Kawahara1, A Iwasaki, Y Yoshinaga
1Second Department of Surgery, Fukuoka University School of Medicine, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|November 18, 2000
Summary
Lymph node metastasis occurs in nearly 30% of small non-small cell lung cancer cases. Even small tumors with pleural involvement show high metastasis rates, necessitating thorough lymph node dissection for accurate staging.
Area of Science:
- Thoracic Surgery
- Oncology
- Pathology
Background:
- Accurate pathological staging is crucial for curative resection of small peripheral non-small cell lung cancers (NSCLC).
- Understanding lymph node metastasis incidence and distribution is essential for NSCLC staging.
Purpose of the Study:
- To determine the incidence and distribution of lymph node metastasis in small peripheral NSCLC.
- To evaluate the necessity of systemic lymph node dissection for staging and treatment.
Main Methods:
- A retrospective study of 64 patients with NSCLC (≤2.0 cm diameter) between 1984 and 1996.
- 49 patients underwent lobectomy with systemic mediastinal dissection (standard lobectomy).
- 15 patients with cardiopulmonary insufficiency underwent limited resection.
Main Results:
- Lymph node metastasis was confirmed in 28.6% of patients undergoing standard lobectomy.
- Tumors with pleural involvement (p2) or subpleural involvement (p1) showed a 63.6% metastasis rate.
- Node-negative patients had significantly better survival (94%) than node-positive patients (44%) after standard lobectomy (p < 0.01).
Conclusions:
- Lymph node involvement is common in small NSCLC, particularly with pleural involvement.
- Systemic hilar and mediastinal dissection is vital for accurate staging and treatment planning in these patients.