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. 2021 Jul;12(14):2078-2084.
doi: 10.1111/1759-7714.14014. Epub 2021 May 25.

Abdominal lymph node metastasis by lymphatic spread through the thoracic duct in patients with non-small-cell lung cancer

Wookyung Ryu #  1 , Myoung Kyu Lee #  2 , Mi Hwa Park #  1 , In Young Hyun  3 , Minkyung Lee  3 , Eun-Ji No  4 , Seok Joong Yong  2 , Jung Soo Kim  1 , Jun Hyeok Lim  1 , Jeong-Seon Ryu  1
Affiliations

Abdominal lymph node metastasis by lymphatic spread through the thoracic duct in patients with non-small-cell lung cancer

Wookyung Ryu et al. Thorac Cancer. 2021 Jul.

Abstract

Background: Abdominal lymph node metastasis (ALNM) is common in patients with metastatic non-small-cell lung cancer (NSCLC). However, its mechanism of spread remains to be elucidated. We investigated whether thoracic duct has the role as a pathway for ALNM in NSCLC using clinical data.

Methods: We classified ALNM into subgroups by their location and evaluated its prevalence and association with clinical characteristics in 892 patients with metastatic NSCLC. The abdominal lymph nodes were classified into direct or indirect groups depending on whether they drain directly into the trunk (intestinal trunk or lumbar trunks) connected to the cisterna chyli.

Results: One hundred-five patients (11.8%) had ALNM. The paraaortic lymph node was most commonly involved, followed by the aortocaval, left gastric, paracaval, and celiac lymph nodes. After grouping the patients by location of ALNM, 56 patients (53.3%) with ALNM were in the "direct only" group, only seven patients (6.7%) were in the "indirect only" group, and 42 patients (40.0%) were in "both" groups. In patients whose intrathoracic lesions were limited to the right thorax, there was a significantly lower prevalence of ALNM (3.4% vs. 14.3%, p < 0.001). On multivariate logistic regression analysis of clinical variables, higher N category was associated with increased risk of ALNM.

Conclusions: This study suggests that the thoracic duct is one of the potential routes of lymphatic spread to the abdominal lymph nodes. Clinicians should assess for the presence of ALNM during staging work-up and follow-up for NSCLC patients with intrathoracic lesion in left thorax and with high N category.

Keywords: abdominal lymph nodelymphatic spreadmetastasisnon-small-cell lung cancerthoracic duct.

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Conflict of interest statement

The authors declare that they have no competing interests to disclose.

Figures

FIGURE 1
FIGURE 1
Distribution of metastatic lymph nodes in the abdomen. Larger symbols indicate higher frequency of metastasis. (a) Lymph nodes surrounding abdominal aorta and vena cava (b) celiac lymph nodes with associated lymph nodes
See this image and copyright information in PMC

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