上葉非小細胞肺癌におけるリンパ節転移パターンが長期生存に及ぼす影響
Nikolas Achilleos1,2, Inna Schott1,2, Fabian Doerr1,2
1University Medical Center Essen, Ruhrlandklinik, Department of Thoracic Surgery, West German Cancer Center, University Duisburg-Essen, Essen, Germany.
Objectives:
While treatment strategies for non-small cell lung cancer (NSCLC) continue to evolve, the prognostic implications of lymph node metastasis patterns in upper lobe tumors remain inadequately defined. This study investigated whether tumour laterality and specific nodal stations involved in N2a disease correlate with long-term survival in patients undergoing surgical resection for upper lobe NSCLC.
Methods:
This retrospective single-center study included patients with stage I-IIIB upper lobe NSCLC who underwent anatomical resection with systematic lymph node dissection from January 2010 to December 2022. Patients were stratified by tumour laterality and nodal involvement, with specific analysis of N2a subgroups based on lymph node station. Propensity score matching, Kaplan-Meier survival analysis, and log-rank testing were used to compare survival outcomes.
Results:
Of 3,313 patients considered, 2,028 met the prespecified inclusion criteria (right: n = 1,212; left: n = 816). Mean age was 65.7 ± 9.4 years; 61.7% were male. Median overall survival (OS) was similar for right- and left-sided N0 and N1 tumors. Significant differences emerged among N2a subgroups: Patients with left-sided skip metastases to LN5/6 had markedly improved OS (66.2 ± 14.9 months) versus right-sided LN2/4 (35.3 ± 8.5 months; p = 0.047). Outcomes of left-sided N2a1 LN5/6 were also more favorable than LN7-9 (37.7 ± 15.2 months; p = 0.023) and showed better OS than left-sided N1 disease (47.6 ± 4.2 months; p = 0.284).
Conclusions:
Positive nodal station and tumour laterality significantly impact survival in upper lobe NSCLC. Skip metastases to LN5/6 in left-sided tumors were linked to more favorable prognosis and may warrant inclusion in future TNM classification refinements.
