Resection of calcified lymph nodes confers clinical benefit in patients with non‑small cell lung cancer

Li,Long; Wang,Xinyuan; Zhang,Min; Yang,Song; Wang,Yuanhan; Xie,Hong; Du,Xiaojun

doi:10.3892/mco.2021.2427

Resection of calcified lymph nodes confers clinical benefit in patients with non‑small cell lung cancer

Authors:
- Long Li
- Xinyuan Wang
- Min Zhang
- Song Yang
- Yuanhan Wang
- Hong Xie
- Xiaojun Du
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Affiliations: Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China, Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
Published online on: October 27, 2021 https://doi.org/10.3892/mco.2021.2427
Article Number: 265
Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the present study was to compare the metastatic ratio between calcified lymph node stations (CLNS) and non‑CLNS (NCLNS) and to explore the impact of CLNS on surgical outcomes. Consecutive patients with non‑small cell lung cancer (NSCLC) scheduled to receive surgical treatment between June and December 2020 were included in the present study. Their clinical and radiological data were prospectively collected and analyzed. A total of 91 patients with NCLNS and 64 patients with CLNS were enrolled in the present study. Out of the 91 patients, 38 (24.516%) patients had 61/343 (17.784%) lymph node stations (LNS) that were metastasized. On a per‑patient basis, the differences in the LNS metastatic ratio were not significant between the CLNS with NCLNS groups. However, on a per‑nodal station basis, all differences in the LNS metastatic ratio between the groups were significant not only in the all‑LNS group (P=0.004), but also in the LNS group which in patients with solely CLNS or NCLNS (P=0.009) and in the patients with CLNS (P=0.010). Pathology, T stage and calcification were independent predictive factors for LNS metastasis (P=0.002, P=0.021 and P=0.044, respectively). More patients with CLNS than patients with NCLNS received thoracotomy or conversion from video‑assisted thoracoscopic surgery to thoracotomy (P=0.006). The operating time and blood loss were significantly higher in patients with CLNS than in those without (P<0.001 and P<0.001, respectively). Although CLNS are a risk reduction factor for metastasis and their dissection is time‑ and blood‑consuming in patients with NSCLC, their thorough removal is advisable, since metastases were identified in ~15% of patients and 9% of CLNS.

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1	Bille A, Woo KM, Ahmad U, Rizk NP and Jones DR: Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients. Eur J Cardiothorac Surg. 51:674–679. 2017.PubMed/NCBI View Article : Google Scholar
2	Smeltzer MP, Faris NR, Ray MA and Osarogiagbon RU: Association of pathologic nodal staging quality with survival among patients with non-small cell lung cancer after resection with curative intent. JAMA Oncol. 4:80–87. 2018.PubMed/NCBI View Article : Google Scholar
3	Zhong W, Yang X, Bai J, Yang J, Manegold C and Wu Y: Complete mediastinal lymphadenectomy: The core component of the multidisciplinary therapy in resectable non-small cell lung cancer. Eur J Cardiothorac Surg. 34:187–195. 2008.PubMed/NCBI View Article : Google Scholar
4	Chiappetta M, Lococo F, Leuzzi G, Sperduti I, Bria E, Petracca Ciavarella L, Mucilli F, Filosso PL, Ratto G, Spaggiari L, et al: Survival analysis in single N2 station lung adenocarcinoma: The prognostic role of involved lymph nodes and adjuvant therapy. Cancers (Basel). 13(1326)2021.PubMed/NCBI View Article : Google Scholar
5	Guo ZY, Ren JH, Xu YY, Liu RJ, Tao H, Huang J and Tan Q: The significance of systematic lymph node dissection in surgery for early-stage non-small cell lung cancer patients aged ≤40 years. J Thorac Dis. 13:1196–1204. 2021.PubMed/NCBI View Article : Google Scholar
6	Osarogiagbon RU, Decker PA, Ballman K, Wigle D, Allen MS and Darling GE: Survival implications of variation in the thoroughness of pathologic lymph node examination in American college of surgeons oncology group Z0030 (Alliance). Ann Thorac Surg. 102:363–369. 2016.PubMed/NCBI View Article : Google Scholar
7	Ettinger DS, Wood DE, Aisner D, et al: NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 5. 2021. Published June 15, 2021. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450. Accessed June 16, 2021.
8	Suwatanapongched T and Gierada DS: CT of thoracic lymph nodes. Part II: Diseases and pitfalls. Br J Radiol. 79:999–1000. 2006.PubMed/NCBI View Article : Google Scholar
9	Brown K, Mund DF, Aberle DR, Batra P and Young DA: Intrathoracic calcifications: Radiographic features and differential diagnoses. Radiographics. 14:1247–1261. 1994.PubMed/NCBI View Article : Google Scholar
10	Mallens WM, Nijhuis-Heddes JM and Bakker W: Calcified lymph node metastases in bronchioloalveolar carcinoma. Radiology. 161:103–104. 1986.PubMed/NCBI View Article : Google Scholar
11	Austin JHM, Grimes MM and Carberry D: CT detection of calcified nodal metastases of lung adenocarcinoma. J Comput Assist Tomogr. 12:314–316. 1988.PubMed/NCBI View Article : Google Scholar
12	Murai T, Hara M, Ozawa Y, Shibamoto Y, Shimizu S and Yano M: Mucinous colloid adenocarcinoma of the lung with lymph node metastasis showing numerous punctate calcifications. Clin Imaging. 35:151–155. 2011.PubMed/NCBI View Article : Google Scholar
13	Nakanishi K, Nakagawa K, Asakura K, Yoshida Y, Watanabe H and Watanabe SI: Is calcification in the regional lymph nodes a benign feature in patients with lung. cancer? World J Surg. 43:1850–1856. 2019.PubMed/NCBI View Article : Google Scholar
14	Park JS, Kim HK, Choi YS, Kim J, Shim YM and Kim K: Unplanned conversion to thoracotomy during video-assisted thoracic surgery lobectomy does not compromise the surgical outcome. World J Surg. 35:590–595. 2011.PubMed/NCBI View Article : Google Scholar
15	Samson P, Guitron J, Reed MF, Hanseman DJ and Starnes SL: Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: A retrospective analysis and the influence of computed tomography-based calcification assessment. J Thorac Cardiovasc Surg. 145:1512–1518. 2013.PubMed/NCBI View Article : Google Scholar
16	Jin KN, Moon HJ, Sung YW, Lee Y and Wi JY: Preoperative computed tomography of the chest in lung cancer patients: The predictive value of calcified lymph nodes for the perioperative outcomes of video-assisted thoracoscopic surgery lobectomy. Eur Radiol. 23:3278–3286. 2013.PubMed/NCBI View Article : Google Scholar
17	Byun CS, Lee S, Kim DJ, Lee JG, Lee CY, Jung I and Chung KY: Analysis of unexpected conversion to thoracotomy during thoracoscopic lobectomy in lung cancer. Ann Thorac Surg. 100:968–973. 2015.PubMed/NCBI View Article : Google Scholar
18	Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, Nicholson AG, Groome P, Mitchell A, Bolejack V, et al: The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 11:39–51. 2016.PubMed/NCBI View Article : Google Scholar
19	Ippoliti R: Institutional review board. In: Encyclopedia of Law and Economics. Backhaus J (ed). Springer, New York, NY, pp1-4, 2015.
20	Sihoe ADL: The evolution of minimally invasive thoracic surgery: Implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis. 6 (Suppl 6):S604–S617. 2014.PubMed/NCBI View Article : Google Scholar
21	Chen W, Zhang H, Du X, Li T and Zhao Y: Characteristics and morbidity of the tuberculosis epidemic-China, 2019. China CDC Wkly. 2:181–184. 2020.
22	Cho S, Song IH, Yang HC, Kim K and Jheon S: Predictive factors for node metastasis in patients with clinical stage I non-small cell lung cancer. Ann Thorac Surg. 96:239–245. 2013.PubMed/NCBI View Article : Google Scholar
23	Lim CG, Shin KM, Lim JS, Lim JK, Kim HJ, Kim WH, Cho SH, Cha SI, Lee EB, Seock Y and Jeong SY: Predictors of conversion to thoracotomy during video-assisted thoracoscopic surgery lobectomy in lung cancer: Additional predictive value of FDG-PET/CT in a tuberculosis endemic region. J Thorac Dis. 9:2427–2436. 2017.PubMed/NCBI View Article : Google Scholar