Xu Song, He Zhicheng, Li Xiongfei, He Jinling, Ni Hong, Ren Dian, Ren Fan, Li Tong, Chen Gang, Chen Liang, Chen Jun
Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Heping District, Tianjin, China.
Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.
Ann Surg Oncol. 2023 Jun;30(6):3760-3768. doi: 10.1245/s10434-023-13235-7. Epub 2023 Mar 10.
An increasing body of evidence supports the noninferiority of sublobar resection compared with lobectomy in terms of survival for patients with early-stage lung cancer with ground-glass opacities (GGOs). However, few studies have focused on the incidence of lymph node (LN) metastases in these patients. We aimed to analyze N1 and N2 lymph node involvement in patients with non-small cell lung cancer (NSCLC) with GGO components stratified with different consolidation tumor ratio (CTR).
We performed two-center studies by retrospectively reviewing a total of 864 patients with NSCLC with semisolid or pure GGO manifestation (diameter ≤ 3 cm). Clinicopathologic features and outcomes were analyzed. We also reviewed 35 studies to characterize the patient with NSCLC population with the GGO manifestation.
In both cohorts, there was no LN involvement for pure GGO NSCLC, while solid predominant GGO exhibited a relatively high LN involvement rate. On the basis of a pooled literature analysis, the incidence of pathologic mediastinal LN was 0% and 3.8% for pure and semisolid GGOs, respectively. GGO NSCLCs with CTR ≤ 0.5 also had rare LN involvement (0.1%).
From two cohorts and pooled literature analysis, LN involvement was not observed in patients with pure GGO, and very few patients with semisolid GGO NSCLC with CTR ≤ 0.5 had LN involvement, revealing that it may be unnecessary to perform lymphadenectomy for pure GGOs, while mediastinal lymph node sampling (MLNS) is enough for semisolid GGOs with CTR ≤ 0.5. For the patients with GGO CTR > 0.5, mediastinal lymphadenectomy (MLD) or MLNS should be considered.
越来越多的证据支持，对于早期磨玻璃影（GGO）肺癌患者，亚肺叶切除在生存率方面不劣于肺叶切除。然而，很少有研究关注这些患者的淋巴结（LN）转移发生率。我们旨在分析不同实性成分肿瘤比例（CTR）分层的非小细胞肺癌（NSCLC）合并GGO成分患者的N1和N2淋巴结受累情况。
我们进行了一项双中心研究，回顾性分析了总共864例具有半实性或纯GGO表现（直径≤3 cm）的NSCLC患者。分析了其临床病理特征和预后。我们还回顾了35项研究，以描述具有GGO表现的NSCLC患者群体。
在两个队列中，纯GGO NSCLC均无LN受累，而实性为主的GGO显示出相对较高的LN受累率。基于汇总的文献分析，纯GGO和半实性GGO的病理纵隔LN发生率分别为0%和3.8%。CTR≤0.5的GGO NSCLC也很少有LN受累（0.1%）。
通过两个队列研究和汇总文献分析，纯GGO患者未观察到LN受累，CTR≤0.5的半实性GGO NSCLC患者极少有LN受累，这表明对于纯GGO可能无需进行淋巴结清扫，而对于CTR≤0.5的半实性GGO，纵隔淋巴结采样（MLNS）就足够了。对于GGO CTR>0.5的患者，应考虑进行纵隔淋巴结清扫（MLD）或MLNS。
