期刊
ANNALS OF SURGICAL ONCOLOGY
卷 28, 期 4, 页码 2088-2098出版社
SPRINGER
DOI: 10.1245/s10434-020-09154-6
关键词
Lung adenocarcinoma; Extracapsular lymph node involvement; Prognosis; N classification
资金
- Shanghai Hospital Development Center [SHDC12015116]
- National Natural Science Foundation of China [NSFC81770091]
- Clinical Research Foundation of Shanghai Pulmonary Hospital [FK1943, FK1936, FK1942, FK1941]
- Shanghai Municipal Health Commission [2018ZHYL0102, 2019SY072, 201940018]
- Science and Technology Commission of Shanghai Municipality [15411968400, 14411962600]
- Suzhou Key Laboratory of Thoracic Oncology [SZS201907]
- Suzhou Key Discipline for Medicine [SZXK201803]
- Municipal Program of People's Livelihood Science and Technology in Suzhou [SS2019061]
- Jiangsu Key Research and Development Plan (Social Development) Project [BE2020653]
Extracapsular lymph node involvement (ECLNI) is a strong predictor of unfavorable overall survival (OS) and recurrence-free survival (RFS) for lung adenocarcinoma (LUAD) patients. Factors such as tumor spread through air spaces are associated with ECLNI presence. ECLNI status provides additional precision in stratifying pN1 and pN2 patients with significantly different RFS and OS outcomes.
Background 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. Patients and Methods 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. Results 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. Conclusions 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.
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