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Han-Yu Deng



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    P1.17 - Treatment of Early Stage/Localized Disease (ID 188)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.17-19 - Lobe-Specific Lymph Node Dissection for Clinical Early-Stage (cIA) Peripheral Non-Small Cell Lung Cancer Patients: Feasible and How? (ID 1098)

      09:45 - 18:00  |  Presenting Author(s): Han-Yu Deng

      • Abstract

      Background

      Currently, the extent of lobe-specific lymph node (LN) dissection (L-SLND) for early-stage non-small cell lung cancer (NSCLC) in previous literatures remains controversial without well-recognized agreement on exact definition of L-SLND. We aimed to investigate the possible lobe-specific LN metastasis pattern of clinical T1N0M0 peripheral NSCLC and define the extent of L-SLND for them.

      Method

      We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic lymphadenectomy for early-stage NSCLC from January 2015 to December 2018. The LN metastasis pattern of them was analyzed by tumor lobe location.

      Result

      A total of 590 patients were included for analysis. The rate of mediastinal LN metastasis was 9.5% (table 1). For cases in the upper lobes and these in the lower lobes, 8.8% and 6.0% of them respectively metastasized to the upper LN zone (P=0.274). However, cases in the upper lobes hardly metastasized to the subcarinal (0.3%) and lower (0.3%) LN zones while it was 10.2% and 5.4% for cases in the lower lobes, respectively (both P<0.001). When stratified by tumor size, all these cases (100%) metastasizing from lower lobes had a tumor size of 2-3 cm while cases with a tumor size ≤2 cm had no metastasis to upper LN zone. For cases in right middle lobe, none of them metastasized to the lower LN zone.

      Table 1. Lymph node metastasis pattern among non-small cell lung cancers in different lobes.

      Characteristics

      Total (N=590)

      Right upper lobe (N=220)

      Right middle lobe (N=48)

      Right lower lobe (N=84)

      Left upper lobe (N=156)

      Left lower lobe (N=82)

      P value

      Total dissected LN number (Mean±SD)

      12.3±5.8

      13.0±4.5

      11.3±5.1

      13.3±6.0

      11.1±5.3

      12.1±5.1

      0.008

      Total dissected mediastinal LN number (Mean±SD)

      8.2±4.1

      9.1±4.5

      8.7±3.9

      9.2±4.8

      6.8±3.2

      7.1±3.2

      <0.001

      LN metastasis rate

      83 (14.1%)

      29 (13.2%)

      8 (16.7%)

      13 (15.5%)

      20 (12.8%)

      13 (15.9%)

      0.915

      Upper zone metastasis rate

      47 (8.0%)

      16 (7.3%)

      4 (8.3%)

      5 (6.0%)

      17 (10.9%)

      5 (6.1%)

      0.586

      Subcarinal zone metastasis rate

      22 (3.7%)

      1 (0.5%)

      4 (8.3%)

      11 (13.1%)

      0 (0%)

      6 (7.3%)

      <0.001

      Lower zone metastasis rate

      10 (1.7%)

      1 (0.5%)

      0 (0%)

      4 (4.8%)

      0 (0%)

      5 (6.1%)

      0.001

      Note: LN=lymph node; SD=standard deviation.

      Conclusion

      A lobe-specific LN metastasis pattern of early-stage peripheral NSCLC was observed and for cases in the upper lobes (≤3cm), there is no need to dissect lower mediastinal LNs and for cases in the lower lobes (≤2cm), there is no need for dissecting upper mediastinal LNs. Otherwise, systematic LN dissection or sampling instead of L-SLND should be recommended.

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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-42 - Surgical Choice for Clinical Stage IA Non-Small Cell Lung Cancer: Novel Rationale from Intrapulmonary Lymph Node Metastasis Pattern (ID 1102)

      10:15 - 18:15  |  Presenting Author(s): Han-Yu Deng

      • Abstract

      Background

      Current available surgical resection methods for early-stage NSCLC mainly consisted of lobectomy and sublobar resection (including segmentectomy and wedge resection) with lobectomy being the preferred option, which was established by the only completed RCT study finding that sublobar resection yielded a significantly higher recurrence rate and a trend toward worse survival than lobectomy. However, there are growing interest in observational studies and systematic reviews exploring the efficacy of sublobar resection in treating early-stage NSCLC, aiming to justify for applying sublobar resection as an alternative to lobectomy for treating these patients but with conflicting conclusions.We aimed to investigate the pattern of intrapulmonary lymph node (LN) metastasis of clinical T1N0M0 peripheral non-small cell lung cancer (NSCLC) to provide novel rationale for surgical choice (lobectomy, segmentectomy, or wedge resection) for these patients.

      Method

      We retrospectively collected clinical data of patients undergoing lobectomy with systematic mediastinal LN dissection or sampling for early-stage NSCLC from January 2015 to December 2018. The intrapulmonary LN metastasis pattern was analyzed by tumor size.

      Result

      We included a total of 354 patients for final analysis. The rate of intrapulmonary LN metastasis was 13.6% (Table 1). When stratified by tumor size, NSCLC ≤1cm had no hilar/intrapulmonary LN metastasis while NSCLC >2 but ≤3cm had significantly high rates of hilar/intrapulmonary LN metastasis (18.4%) and the rates of hilar, interlobar and peripheral LN metastasis were relatively high (5.4%, 5.4% and 12.2%, respectively). NSCLC >1.5cm but ≤2cm also had a relatively high rate of hilar (6.5%) and peripheral (18.3%) LN metastasis while NSCLC >1cm but ≤1.5cm had a significantly low rate of hillar/intrapulmonary (2.5%) and peripheral (2.5%) LN metastasis.

      Table 1. Intrapulmonary lymph node metastasis pattern among clinical stage IA (cT1N0M0) peripheral non-small cell lung cancers with different tumor size.

      Characteristics

      Total (N=354)

      Tumor size group

      P value

      ≤1cm (N=35)

      >1cm but ≤2cm (N=172)

      >2cm but ≤3cm (N=147)

      Total dissected N1 LN number (Mean±SD)

      5.6±3.0

      3.6±1.9

      5.4±2.7

      6.3±3.3

      <0.001

      Total dissected N2 LN number (Mean±SD)

      8.1±4.0

      7.0±3.4

      7.6±3.6

      8.8±4.4

      0.008

      Lymph node metastasis rate

      16.9% (60/354)

      0 (0/35)

      14.5% (25/172)

      23.8% (35/147)

      0.002

      N1 LN metastasis rate (10-14#)

      13.6%(48/354)

      0(0/35)

      12.2%(21/172)

      18.4%(27/147)

      0.013

      Hilar LN metastasis rate (10#)

      4.2%(15/354)

      0(0/35)

      4.1%(7/172)

      5.4%(8/147)

      0.348

      Interlobar LN metastasis rate (11#)

      3.4%(12/354)

      0(0/35)

      2.3%(4/172)

      5.4%(8/147)

      0.263*

      Peripheral LN metastasis rate (12-14#)

      10.5%(37/354)

      0(0/35)

      11.0%(19/172)

      12.2%(18/147)

      0.092

      N2 LN metastasis rate (1-9#)

      8.8%(31/354)

      0(0/35)

      8.1%(14/172)

      11.6%(17/147)

      0.088

      Note: LN=lymph node; SD=standard deviation. *Fisher’s exact test

      Conclusion

      Based on the pattern of intrapulmonary LN metastasis, our study provided novel perspectives on surgical choice of lobectomy, segmentectomy, or wedge resection for clinical stage IA peripheral NSCLC: for NSCLC ≤1cm both segmentecotmy and wedge resection could be utilized, and for NSCLC >1cm but ≤1.5cm segmentecotmy could be utilized provided that sufficient resection margin could be achieved; while for NSCLC >1.5cm lobectomy should be the preferred surgical option.