Journal of thoracic disease · 2026
Mediastinal lymph node metastasis pattern of subsolid non-small cell lung cancer.
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Sun Xiao, Xin Yanlu, Jia Yanjun, Wang Hao, Cui Xiangyu, Chen Jun
Аннотация
BACKGROUND: Lymph node (LN) dissection is important in lung cancer surgery. LN metastasis was analyzed in each stage of non-small cell lung cancer (NSCLC) to inform the resection strategy, especially for subsolid nodules. This study aimed to explore LN metastasis distribution features of NSCLC, with a focus on subsolid nodules.
METHODS: Patients with NSCLC treated from January 2014 to December 2018 (n=6,273) were retrospectively grouped according to primary tumor locations and clinical stages. The incidence and distribution of LN metastasis were analyzed.
RESULTS: Clinical and pathological characteristics varied with different primary lesion locations. LN metastasis occurred in 1,356 patients (21.62%). Lobe-specific distribution was observed on mediastinal LN metastasis. However, LN metastasis in each region exceeded 5%, which warrants careful attention during surgical dissection. Subgroup analysis indicated more regular lobe-specific distribution in cT1N0 lesions, but not in advanced stages. LN metastasis was negligible (<1%) in subsolid nodules (≤3 cm) with radiographic consolidation-to-tumor ratio (CTR) ≤0.5, but significant in the CTR >0.5 group (2.34-6.60%) in each mediastinal region. For upper lobe tumors, upper mediastinum was invaded frequently (right, 4.34%; left 5.70%). In right middle lobe, the mediastinal (5.21%) or sub-carinal (6.06%) region was involved. Tumor invasion in lower lobes included the upper (left, 3.38%; right, 2.49%), sub-carinal (right, 5.88%; left, 4.00%) and lower (right, 2.34%; left, 2.33%) regions. Prognosis was significantly better in the CTR ≤0.5 group compared to the CTR >0.5 group (P<0.0001).
CONCLUSIONS: Subsolid tumors with CTR ≤0.5 demonstrate an extremely low risk of mediastinal LN metastasis, which may help guide individualized lymphadenectomy strategies. For tumors with CTR >0.5, metastatic risk is significantly higher, suggesting more comprehensive LN evaluation may be warranted.
METHODS: Patients with NSCLC treated from January 2014 to December 2018 (n=6,273) were retrospectively grouped according to primary tumor locations and clinical stages. The incidence and distribution of LN metastasis were analyzed.
RESULTS: Clinical and pathological characteristics varied with different primary lesion locations. LN metastasis occurred in 1,356 patients (21.62%). Lobe-specific distribution was observed on mediastinal LN metastasis. However, LN metastasis in each region exceeded 5%, which warrants careful attention during surgical dissection. Subgroup analysis indicated more regular lobe-specific distribution in cT1N0 lesions, but not in advanced stages. LN metastasis was negligible (<1%) in subsolid nodules (≤3 cm) with radiographic consolidation-to-tumor ratio (CTR) ≤0.5, but significant in the CTR >0.5 group (2.34-6.60%) in each mediastinal region. For upper lobe tumors, upper mediastinum was invaded frequently (right, 4.34%; left 5.70%). In right middle lobe, the mediastinal (5.21%) or sub-carinal (6.06%) region was involved. Tumor invasion in lower lobes included the upper (left, 3.38%; right, 2.49%), sub-carinal (right, 5.88%; left, 4.00%) and lower (right, 2.34%; left, 2.33%) regions. Prognosis was significantly better in the CTR ≤0.5 group compared to the CTR >0.5 group (P<0.0001).
CONCLUSIONS: Subsolid tumors with CTR ≤0.5 demonstrate an extremely low risk of mediastinal LN metastasis, which may help guide individualized lymphadenectomy strategies. For tumors with CTR >0.5, metastatic risk is significantly higher, suggesting more comprehensive LN evaluation may be warranted.