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C. Liang



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    MA 13 - New Insights of Diagnosis and Update of Treatment (ID 674)

    • Event: WCLC 2017
    • Type: Mini Oral
    • Track: Early Stage NSCLC
    • Presentations: 1
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      MA 13.11 - Clinical Significance of Lobar and Segmental Lymph Node Metastasis in cT1N0M0 Lung Adenocarcinoma (ID 7311)

      15:45 - 17:30  |  Author(s): C. Liang

      • Abstract
      • Presentation
      • Slides

      Background:
      The regularity of intrapulmonary lobar and segmental lymph node (LSN) metastasis in cT1N0M0 stage lung adenocarcinoma remains unclear. Thus, segmentectomy with uncertain LSNs metastatic status remains a potential oncological risk. We aimed to facilitate more accurate determination of N staging and identification of more suitable cases for segmentectomy.

      Method:
      A prospective study was performed from March 2014 to March 2016. A total of 156 patients diagnosed with cT1N0M0 stage lung adenocarcinoma received lobectomy and mediastinal lymph node dissection. The intrapulmonary LSNs were dissected and classified as adjacent LSNs or isolated LSNs. The metastatic status of the LSNs together with the TNM stage were analyzed. A comparison of the metastatic probability of isolated LSNs was carried out considering imaging features, serum carcinoembryonic (CEA) levels, pathological subtypes, size of the lesions, and metastatic status of adjacent LSNs.

      Result:
      Among the 156 cases enrolled, 129 were confirmed as pN0, 21 as pN1, 5 as pN1+N2, and 1 as skip pN2. When the LSNs had not been dissected, the false negative rate for N staging was 5.1% (7/136). Patients with a pure ground-glass-nodule had a lower isolated LSN metastasis rate (p = 0.027). Non-lepidic predominant invasive adenocarcinoma (p = 0.003), the cT1c group (p = 0.020), and those with adjacent LSN metastasis (p < 0.001) were detected with a higher isolated LSN metastasis rate. No significant difference in isolated LSN metastasis rate was found between groups with different serum CEA levels (p = 0.121).

      Conclusion:
      Dissection of intrapulmonary LSNs reduces the false negative rate of lymph node metastasis. Partial solid or solid lung adenocarcinoma, non-lepidic predominant invasive adenocarcinoma, and cT1c lung adenocarcinoma might not be suitable for segmentectomy. The lymph node sampling area during segmentectomy should include adjacent LSNs of the target segment. When metastasis to the adjacent LSNs is confirmed by fast frozen pathology, segmentectomy would not be suitable.

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