The Oncologic Significance of Station 9 Nodes During Lobectomies
Presented During:
Saturday, May 6, 2023: 8:00AM - Tuesday, May 9, 2023: 11:45AM
Los Angeles Convention Center
Posted Room Name:
Outside of Room 408
Abstract No:
PS073
Submission Type:
Abstract Submission
Authors:
Anupama Singh (1), Rafael Barcelos (1), Michael Jaklitsch (1), Paula Ugalde Figueroa (1), Fatima Wilder (1)
Institutions:
(1) Brigham and Women's Hospital, Boston, MA
Submitting Author:
Anupama Singh
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Brigham and Women's Hospital
Brigham and Women's Hospital
Co-Author(s):
Rafael Ribeiro Barcelos
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Brigham and Women's Hospital
Brigham and Women's Hospital
*Michael Jaklitsch
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Brigham and Women's Hospital
Brigham and Women's Hospital
*Paula Ugalde Figueroa
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Brigham and Women's Hospital
Brigham and Women's Hospital
Fatima Wilder
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Brigham and Women's Hospital
Brigham and Women's Hospital
Presenting Author:
Anupama Singh
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Abstract:
Objective: To evaluate the clinical significance of sampling station 9 nodes during lobectomy for primary NSCLC and its association with oncologic outcome.
Methods: A single center retrospective analysis of patients who underwent a lobectomy for primary NSCLC from 8/2020 – 9/2022. Patients with fewer than 3 N2 stations sampled, secondary pulmonary metastasis, and diagnosis other than NSCLC were excluded. PET-avidity and final pathology results were documented for station 9 nodes along with the associated lobe of the primary tumor. Median follow-up was 12 months.
Results: 419 lobectomies were performed from 8/2020 – 9/2022 of which Station 9 was sampled in 126 cases. 37 cases with less than 3 N2 stations sampled and 1 case of pulmonary metastasis were excluded. 89 lobectomies with R0 resection for primary NSCLC with station 9 nodes sampled were analyzed (46 upper lobe, 3 middle lobe, 40 lower lobe). There were 46 females (52%) and 73 cases of adenocarcinoma (82%), 14 squamous cell carcinoma (16%) and 2 large cell cancers (2%). Station 9 nodes were pathologically positive in 5 cases (6%), negative in 79 cases (89%), and non-diagnostic in 5 cases (6%). The non-diagnostic results demonstrated fibroadipose tissue without lymphoid tissue. There was 1 case (1%) of PET-avid station 9 node. The 5 cases of positive station 9 nodes were only associated with tumors in the middle and lower lobes and none in the upper lobes. 68 patients (76%) were included in follow-up analysis. After excluding non-diagnostic nodes, 26 patients with middle and lower lobe tumors were included. 3 patients (12%) had locoregional recurrence (pathologic stages IA, IIIA), 2 (8%) had distant recurrence (IIA, IIB), and 1 patient (4%) had both (IIB). 2 of the patients who recurred (IIIA) had multi-station N2 disease. One had a positive station 9 node and one negative. Relationship among station 9 disease, pathologic stage, and number of recurrences is shown in table 1.
Conclusions: Occult metastasis to station 9 nodes associated with middle and lower lobe cancers is surprisingly common (4 of 43, 9%) and is not seen in primary NSCLC of upper lobes. Station 9 lymph nodes should be sampled for primary NSCLC of middle and lower lobes.
Methods: A single center retrospective analysis of patients who underwent a lobectomy for primary NSCLC from 8/2020 – 9/2022. Patients with fewer than 3 N2 stations sampled, secondary pulmonary metastasis, and diagnosis other than NSCLC were excluded. PET-avidity and final pathology results were documented for station 9 nodes along with the associated lobe of the primary tumor. Median follow-up was 12 months.
Results: 419 lobectomies were performed from 8/2020 – 9/2022 of which Station 9 was sampled in 126 cases. 37 cases with less than 3 N2 stations sampled and 1 case of pulmonary metastasis were excluded. 89 lobectomies with R0 resection for primary NSCLC with station 9 nodes sampled were analyzed (46 upper lobe, 3 middle lobe, 40 lower lobe). There were 46 females (52%) and 73 cases of adenocarcinoma (82%), 14 squamous cell carcinoma (16%) and 2 large cell cancers (2%). Station 9 nodes were pathologically positive in 5 cases (6%), negative in 79 cases (89%), and non-diagnostic in 5 cases (6%). The non-diagnostic results demonstrated fibroadipose tissue without lymphoid tissue. There was 1 case (1%) of PET-avid station 9 node. The 5 cases of positive station 9 nodes were only associated with tumors in the middle and lower lobes and none in the upper lobes. 68 patients (76%) were included in follow-up analysis. After excluding non-diagnostic nodes, 26 patients with middle and lower lobe tumors were included. 3 patients (12%) had locoregional recurrence (pathologic stages IA, IIIA), 2 (8%) had distant recurrence (IIA, IIB), and 1 patient (4%) had both (IIB). 2 of the patients who recurred (IIIA) had multi-station N2 disease. One had a positive station 9 node and one negative. Relationship among station 9 disease, pathologic stage, and number of recurrences is shown in table 1.
Conclusions: Occult metastasis to station 9 nodes associated with middle and lower lobe cancers is surprisingly common (4 of 43, 9%) and is not seen in primary NSCLC of upper lobes. Station 9 lymph nodes should be sampled for primary NSCLC of middle and lower lobes.
Categories:
Lung Cancer
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