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Lobe-Specific Lymph Node Dissection May be Feasible for Clinical N0 Solid-Predominant Part-Solid Lung Adenocarcinoma
Yang Wo1, Hang Li1, Zhencong Chen2
1Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Lymph node metastasis occurs in 10% of solid-predominant part-solid nodules (PSNs). Lobe-specific lymph node dissection (LND) may be safe for PSNs with solid components ≤ 2 cm, but systematic LND is advised otherwise.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Lymph node (LN) involvement is common in patients with radiological solid-predominant part-solid nodules (PSNs).
- The optimal lymph node dissection (LND) strategy for these patients remains unclear.
Purpose of the Study:
- To investigate the incidence and pattern of LN metastasis in solid-predominant PSNs.
- To evaluate the feasibility of lobe-specific LND versus systematic LND.
Main Methods:
- Retrospective analysis of 672 patients with clinical N0 solid-predominant PSNs undergoing systematic or limited LND (development cohort).
- Analysis of a validation cohort of 7273 patients with lung adenocarcinomas to confirm LN metastasis patterns.
- Comparison of clinical outcomes to assess LND strategy feasibility.
Main Results:
- The LN involvement rate was 10.0% for solid-predominant PSNs.
- Larger solid component diameter was associated with increased LN involvement risk.
- A lobe-specific LN metastasis pattern was identified for PSNs with solid component diameter ≤ 2 cm; oncologic outcomes did not differ based on LND extent in this subgroup.
Conclusions:
- Lobe-specific LND may be a feasible approach for solid-predominant PSNs with a solid component diameter ≤ 2 cm.
- Systematic LND is recommended for solid-predominant PSNs with larger solid components.
