Chen Donglai, Ding Qifeng, Wang Wei, Wang Xiaofan, Wu Xuejie, Mao Yiming, Chen Chang, Chen Yongbing, Zhang Yongsheng
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Ann Surg Oncol. 2021 Apr;28(4):2088-2098. doi: 10.1245/s10434-020-09154-6. Epub 2020 Oct 4.
The prognostic impact and clinicopathological characteristics of extracapsular lymph node involvement (ECLNI) in patients with surgically resected lung adenocarcinoma (LUAD) remain unknown in the context of the eighth edition N classification.
We retrospectively reviewed 279 patients with stage II-IIIA LUAD who underwent lobectomy and lymphadenectomy. The correlations of ECLNI presence and clinicopathological profiles were analyzed. We also assessed the impact of ECLNI on the postoperative survival of pN1 and pN2 LUAD patients.
ECLNI-positive status was more common in patients with high lymph node yield and in patients with multiple stations involved. The logistic regression model identified tumor spread through air spaces, micropapillary component, cribriform component, and nodal stage as predictive factors for ECLNI presence. LUAD patients with ECLNI presence had an increased risk of locoregional recurrence compared with those without (p < 0.001). Presence of ECLNI was confirmed as an independent risk factor for worse recurrence-free survival (RFS) (p < 0.001) and overall survival (OS) (p < 0.001) in the entire cohort. Among the 61 patients with ECLNI(+)pN2 disease, our analysis revealed that adjuvant radiation was a significant predictor of improved RFS and OS. In addition, ECLNI status provides additional precision in stratifying pN1 and pN2 patients with significantly different RFS and OS.
Our data suggest that ECLNI remains a strong prognosticator of unfavorable OS and RFS for LUADs in the context of the eighth edition N classification. Adjuvant radiation should be actively considered for pN1b and pN2 LUAD patients with ECLNI presence.
在第八版N分类的背景下，手术切除的肺腺癌（LUAD）患者的包膜外淋巴结受累（ECLNI）的预后影响和临床病理特征仍不清楚。
我们回顾性分析了279例接受肺叶切除术和淋巴结清扫术的II-IIIA期LUAD患者。分析了ECLNI的存在与临床病理特征之间的相关性。我们还评估了ECLNI对pN1和pN2期LUAD患者术后生存的影响。
ECLNI阳性状态在淋巴结收获量高的患者和多站受累的患者中更为常见。逻辑回归模型确定通过气腔扩散、微乳头成分、筛状成分和淋巴结分期为ECLNI存在的预测因素。与无ECLNI的LUAD患者相比，有ECLNI的患者局部区域复发风险增加（p < 0.001）。在整个队列中，ECLNI的存在被确认为无复发生存期（RFS）较差（p < 0.001）和总生存期（OS）较差（p < 0.001）的独立危险因素。在61例ECLNI(+)pN2疾病患者中，我们的分析显示辅助放疗是RFS和OS改善的显著预测因素。此外，ECLNI状态在分层pN1和pN2患者时提供了额外的精确性，其RFS和OS有显著差异。
我们的数据表明，在第八版N分类的背景下，ECLNI仍然是LUAD患者OS和RFS不良的有力预后指标。对于存在ECLNI的pN1b和pN2期LUAD患者，应积极考虑辅助放疗。
