Occult metastasis to station 9 thoracic lymph nodes is common in middle and lower lobe non-small cell lung cancer (NSCLC), according to research presented in a poster at the American Association for Thoracic Surgery (AATS) Annual Meeting.
Based on these findings, researchers recommended that station 9 nodes be sampled for primary NSCLC of the middle and lower lobes.
In this retrospective study, researchers sought to evaluate the clinical significance of sampling station 9 nodes during lobectomy for primary NSCLC.
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The researchers examined data from 89 patients who had undergone lobectomy for primary NSCLC with at least 3 N2 nodes sampled. Of these patients, 46 had upper lobe, 3 had middle lobe, and 40 had lower lobe NSCLC.
Patients were 35 to 86 years of age, 47% of patients were men, 92% were White, and 76% had adenocarcinoma. Patients had central (53%) and peripheral (48%) tumors. The most common surgical procedure was video-assisted thorascopic surgery (49%), followed by robotic (35%) and open (15%) surgery.
Station 9 lymph nodes were pathologically positive in 5 patients, all of whom had middle or lower lobe disease. Three of these patients had stage IIIA disease, and 2 had stage IIIB NSCLC.
In a follow-up analysis, recurrence data were available for 64 patients, including 26 patients with middle and lower lobe tumors.
Among the 38 patients with negative station 9 nodes and upper lobe tumors, 2 patients with stage IA disease had recurrence (1 locoregional, 1 both distant and locoregional). One patient with stage IB disease and 1 patient with stage IIB disease had distant recurrence.
Among the 21 patients with negative station 9 nodes and middle or lower lobe tumors, 1 patient with stage IA disease and 1 patient with stage IIIA disease had locoregional recurrence. One patient with stage IIA disease had distant recurrence. Two patients with stage IIIB disease had recurrence (1 distant, 1 both distant and locoregional).
Among the 5 patients with positive station 9 nodes and middle or lower lobe tumors, 1 patient with stage IIIA disease had locoregional recurrence.
“Occult metastasis to station 9 nodes associated with middle and lower lobe tumors is common (9%) and is not seen in primary NSCLC of upper lobes,” the researchers wrote in their poster. “Station 9 lymph nodes should be sampled for primary NSCLC of middle and lower lobes.”
Reference
Singh A, Barcelos R, Jaklitsch M, Figueroa PU, Wilder F. The oncologic significance of station 9 nodes during lobectomies. AATS 2023. May 6-9, 2023. Abstract PS73.
