Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 11:13:1124014.
doi: 10.3389/fonc.2023.1124014. eCollection 2023.

Clinicopathological and survival outcomes of 4L lymph node dissection in left lung adenocarcinoma and squamous cell carcinoma

Leilei Shen  1   2   3 , Juntang Guo  1   2   3 , Weidong Zhang  1   2   3 , Chaoyang Liang  1   2   3 , Han Chen  4 , Yang Liu  1   2   3
Affiliations

Clinicopathological and survival outcomes of 4L lymph node dissection in left lung adenocarcinoma and squamous cell carcinoma

Leilei Shen et al. Front Oncol. .

Abstract

Background: Whether 4L lymph node dissection (LND) should be performed remains unclear and controversial. Prior studies have found that station 4L metastasis was not rare and that 4L LND may provide survival benefits. The objective of this study was to analyze the clinicopathological and survival outcomes of 4L LND from the perspective of histology.

Methods: This retrospective study included 74 patients with squamous cell carcinoma (SCC) and 84 patients diagnosed with lung adenocarcinoma (ADC) between January 2008 and October 2020. All patients underwent pulmonary resection with station 4L LND and were staged as T1-4N0-2M0. Clinicopathological features and survival outcomes were investigated based on histology. The study endpoints were disease-free survival (DFS) and overall survival (OS).

Results: The incidence rate of station 4L metastasis was 17.1% (27/158) in the entire cohort, with 8.1% in the SCC group, and 25.0% in the ADC group. No statistical differences in the 5-year DFS rates (67.1% vs. 61.7%, P=0.812) and 5-year OS rates (68.6% vs. 59.3%, P=0.100) were observed between the ADC group and the SCC group. Multivariate logistic analysis revealed that histology (SCC vs. ADC: OR, 0.185; 95% CI, 0.049-0.706; P=0.013) was independently associated with 4L metastasis. Multivariate survival analysis showed that the status of 4L metastasis was an independent factor for DFS (HR, 2.563; 95% CI, 1.282-5.123; P=0.008) but not for OS (HR, 1.597; 95% CI, 0.749-3.402; P=0.225).

Conclusion: Station 4L metastasis is not rare in left lung cancer. Patients with ADC have a greater predilection for station 4L metastasis and may benefit more from performing 4L LND.

Keywords: adenocarcinoma; lymph node dissection; prognosis; squamous cell carcinoma; station 4L metastasis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study enrollment flow diagram.
Figure 2
Figure 2
Disease-free survival (A) and overall survival (B) of patients in the ADC group and SCC group.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2022. CA Cancer J Clin (2022) 2:7–33. doi: 10.3322/caac.21708 - DOI - PubMed
    1. Watanabe S, Asamura H. Lymph node dissection for lung cancer: Significance, strategy, and technique. J Thorac Oncol (2009) 4:652–7. doi: 10.1097/JTO.0b013e31819cce50 - DOI - PubMed
    1. National Comprehensive Cancer Network . NCCN guideline for non-small cell lung cancer (2022). Available at: https://www.nccn.org/professionals/ (Accessed March 16, 2022).
    1. Reinersman JM. Better survival after 4L lymph node dissection for early-stage, left-sided, non-small cell lung cancer: Are we debating a false duality? Ann Surg Oncol (2019) 26:1959–60. doi: 10.1245/s10434-019-07382-z - DOI - PubMed
    1. Riquet M. Bronchial arteries and lymphatics of the lung. Thorac Surg Clin (2007) 17:619–38. doi: 10.1016/j.thorsurg.2006.12.011 - DOI - PubMed