Predictors of lymph node metastasis and possible selective lymph node dissection in clinical stage IA non-small cell lung cancer

作者：Ningning Ding, Yousheng Mao, Shugeng Gao, Qi Xue, Dali Wang, Jun Zhao, Yushun Gao, Jinfeng Huang, Kang Shao, Feiyue Feng, Yue Zhao, Ligong Yuan · 发表于：Journal of Thoracic Disease · 年份：2018 · DOI：10.21037/jtd.2018.06.129 · 被引用次数：49 · 研究领域：Lung Cancer Diagnosis and Treatment、Radiomics and Machine Learning in Medical Imaging、Breast Cancer Treatment Studies

BACKGROUND: The pathologic stages of lymph nodes usually differ from preoperatively predicted in lung cancers and it is difficult to predict the metastasis of lymph nodes for the patients diagnosed as clinical stage IA non-small cell lung cancers (NSCLC). This study aimed to investigate the patterns of lymph node metastasis and the risk factors predicting lymph node metastasis in the patients with clinical stage IA NSCLCs. METHODS: All patients diagnosed as clinical stage IA NSCLC from July 2013 to June 2017 in our center were retrospectively reviewed, and a total number of 1,543 patients who underwent anatomical lobectomy with systematic lymph node dissection were enrolled in this study. Multivariate logistic regression analysis was performed to identify the risk factors predicting lymph node metastasis, and Fisher's exact test was used to confirm the lymph node spread mode according to the locations of primary tumors. RESULTS: Totally, lymph node metastases presented in 131 patients (8.5%) in this series. Sixty-three patients presented N1 diseases, 17 patients showed only skipped N2 diseases, and 51 patients had simultaneous N1 and N2 positive lymph nodes. No lymph node metastasis was found in the patients with pure ground grass opacity (GGO). When patients were arbitrarily divided into six groups by the longest tumor diameter of ≤0.5, 0.6-1, 1.1-1.5, 1.6-2.0, 2.1-2.5, 2.6-3 cm, the lymph node metastasis rates of each group were 0% (0/20), 1.5% (4/264), 4.7% (20/429), 8.6% ...