2022 World Conference on Lung Cancer (Posters)-P2.06-01. Skip Hilar Lymph Node Metastasis in Non-Small Cell Lung Cancer Has Similar Survival to N0 Disease: Need for a change in the pN sub-classification?

P2.06-01. Skip Hilar Lymph Node Metastasis in Non-Small Cell Lung Cancer Has Similar Survival to N0 Disease: Need for a change in the pN sub-classification?

Back to course

Pdf Summary

This study aimed to investigate the survival difference between patients with skip hilar lymph node metastasis only and other N1a patients in non-small cell lung cancer (NSCLC). A total of 629 patients who underwent surgery between February 2003 and February 2019 were retrospectively analyzed. Patients with oligometastases or neoadjuvant treatment, as well as those with insufficient follow-up data, were excluded.<br /><br />The study found that skip hilar lymph node metastasis had a similar survival rate to N0 disease and was significantly better than non-skip N1 disease. As a result, the authors suggest a change in the pN sub-classification for the 9th edition of TNM staging studies, proposing that patients with skip hilar lymph node metastasis should be staged as pN1a1.<br /><br />However, the mechanism behind this prognostic advantage and the verification of these findings require further studies with larger patient series. <br /><br />Lymph node metastasis in NSCLC is generally considered a negative prognostic factor, as it can lead to recurrences and distal metastasis through the lymphatic system. Mediastinal lymph nodes are the focal point of attention, while other N1 lymph nodes, especially during surgery, are often overlooked. N1 disease, although not a surgical contraindication, also deserves attention as it signifies an aggressive behavior of the primary tumor and preoperative clinical detection is often inadequate.<br /><br />The previous edition of the TNM staging system divided N1 disease into two subgroups based on the number of stations involved. Additionally, there are studies on the number of nodal stations involved, ignoring anatomical nodal mapping.<br /><br />In this study, overall survival of patients with skip hilar lymph node metastasis was similar to N0 patients, whereas it was statistically significantly better than N1a and N1b patients. The overall survival of N1a patients without skip hilar metastasis was 95 months, while N1b patients had an overall survival of 65 months.<br /><br />In conclusion, this study suggests that skip hilar lymph node metastasis should be considered in the pN sub-classification for NSCLC staging. Further research is needed to better understand the mechanism behind this advantage and to confirm these findings.

Asset Subtitle

Ismail Sarbay, Turkey

Meta Tag

Speaker Ismail Sarbay, Turkey

Topic Pathology - Tumour Diagnostics

Keywords

skip hilar lymph node metastasis

N1a patients

non-small cell lung cancer

surgery

pN sub-classification

TNM staging studies

lymph node metastasis

negative prognostic factor

aggressive behavior

overall survival