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. 2024 Sep;168(3):674-683.e1.
doi: 10.1016/j.jtcvs.2023.11.023. Epub 2023 Nov 23.

Lymph node dissection in small peripheral lung cancer: Supplemental analysis of JCOG0802/WJOG4607L

Tomohiro Maniwa  1 , Jiro Okami  2 , Tomohiro Miyoshi  3 , Masashi Wakabayashi  4 , Hiroshige Yoshioka  5 , Takahiro Mimae  6 , Makoto Endo  7 , Aritoshi Hattori  8 , Kazuo Nakagawa  9 , Tetsuya Isaka  10 , Mitsuhiro Isaka  11 , Ryosuke Kita  4 , Yuta Sekino  4 , Noriko Mitome  4 , Keiju Aokage  3 , Hisashi Saji  12 , Ryu Nakajima  13 , Morihito Okada  7 , Masahiro Tsuboi  3 , Hisao Asamura  14 , Haruhiko Fukuda  4 , Shun-Ichi Watanabe  9 ; West Japan Oncology Group and Japan Clinical Oncology Group
Affiliations

Lymph node dissection in small peripheral lung cancer: Supplemental analysis of JCOG0802/WJOG4607L

Tomohiro Maniwa et al. J Thorac Cardiovasc Surg. 2024 Sep.

Abstract

Objective: The optimal region of lymph node dissection (LND) during segmentectomy in patients with small peripheral non-small cell lung cancer requires clarification. Through a supplemental analysis of the Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L, we investigated the associated factors, distribution, and recurrence pattern of lymph node metastases (LNMs) and proposed the optimal LND region.

Methods: Of the 1106 patients included in the JCOG0802/WJOG4607L, 1056 patients with LNDs were included in this supplemental analysis. We investigated the distribution and recurrence pattern of LNMs along with the radiologic findings (with ground-glass opacity, part-solid tumor; without ground-grass opacity component, pure-solid tumor).

Results: The radiologic findings were the only significant factor for LNMs. Of 533 patients with part-solid tumors, 8 (1.5%) had LNMs. Further, only 3 (0.5%) patients had pN2 disease, and no patients had interlobar LNMs from nonadjacent segments. Of the 523 patients with pure-solid tumors, 55 (10.5%) had LNMs, and 28 (5.4%) had pN2 disease. Five patients had metastases to nonadjacent interlobar lymph nodes (LNs). Two (2.0%) patients with S6 tumors had upper mediastinal LNMs. In addition, the incidence of mediastinal LN recurrence in patients with S6 lung cancer was greater in those who underwent selective LND than those who underwent systematic LND (P = .0455).

Conclusions: Nonadjacent interlobar and mediastinal LND have little impact on pathologic nodal staging in patients with part-solid tumors. In contrast, selective LND is recommended at least for patients with pure-solid tumors.

Keywords: lymph node metastasis; mediastinal lymph node dissection; non–small cell lung cancer; small.

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Conflict of interest statement

Conflict of Interest Statement H.Y. reported honoraria from Eli Lilly, Chugai, Boehringer Ingelheim, Nippon Kayaku, Astra Zeneca, Bristol-Myers Squibb, Merck Sharp and Dohme, Ono, Merck Biopharma, Taiho, Otsuka, Takeda, Novartis, Amgen, Nipro Pharma, Kyowa Kirin, and Pfizer (payments were made to the author) and consulting fees from Delta Fly Pharma (payments were made to the author). M.T. reported participation on a Data Safety Monitoring Board or Advisory Board, Chugai Pharmaceutical Co, Ltd. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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