Koen C. H. A. Verkoulen, Jean H. T. Daemen, Aimée J. P. M. Franssen, Juliette H. R. J. Degens, Karel W. E. Hulsewé, Yvonne L. J. Vissers, Erik R. de Loos
<p>In a recent issue of <i>The Clinical Respiratory Journal</i>, Guo et al. published a study that evaluated the correlation between the rate and number of resected metastatic lymph nodes and survival in patients undergoing an anatomical resection for non–small cell lung cancer (NSCLC) [<span>1</span>]. To date, nodal staging is key in the work-up and treatment guidance for NSCLC as it is an important determinant of survival [<span>2, 3</span>]. As opposed to some other cancer types, nodal staging for lung cancer is based on the anatomic location of the respective regional and mediastinal lymph node stations rather than the number of metastasis [<span>4-6</span>]. Hence, the ongoing debate concerning the potential prognostic value of the number and rate of lymph node metastases in NSCLC continues. Over the last decade, numerous studies have aimed to address this issue [<span>7-10</span>]. However, they are generally limited by their retrospective design and inherent bias, as well as methodological disparity [<span>11</span>]. How does the current report add to the evidence collected for over more than a decade?</p><p>Guo et al. carried out the first population-based study concerning this subject. They revealed that both the number and rate of positive lymph nodes after lymphadenectomy concomitant to an anatomical lung parenchyma resection are a predictor for overall survival, independent of the anatomical location of the nodal station that is affected, being either N1 or N2. These results are in line with prior retrospective studies and a recently published meta-analysis [<span>8, 10, 12</span>]. However, the number and rate of metastatic lymph nodes was only examined in postoperative patients that underwent lymphadenectomy, in whom the lymph nodes were completely dissected (defined as examination of more than 15 dissected lymph nodes) instead of biopsied stations. Thus, these results are only applicable as a prognostic tool and in treatment decision-making processes for postoperative patients. To be of an even greater importance for treatment plan composition, for example, one should repeat this study for preoperative clinical lymph node staging (cTNM) using minimally invasive staging techniques like endosonographic lymph node staging (EUS/EBUS) or surgical video-assisted mediastinoscopy (VAM) or video-assisted mediastinoscopic lymphadenectomy (VAMLA). However, a recent publication showed in a noninferiority study that VAMLA might not be of added value in patients that underwent systemic EUS/EBUS [<span>13</span>]. Additionally, VAM/VAMLA or EUS is mainly used to assess N2 nodes. Hence, the vast majority of metastatic N1 nodes cannot be evaluated through these techniques. These drawbacks illustrate the challenges of the current TNM classification, and lymph node staging, especially for clinical lymph node staging. The sensitivity of preoperative lymph node staging modalities like (PET)-CT scan and EUS/EBUS ranges from 20% to 70%, resulting in a
{"title":"Is It Time to (Re)define the N-Category for Metastatic Lymph Nodes in Non–Small Cell Lung Cancer?","authors":"Koen C. H. A. Verkoulen, Jean H. T. Daemen, Aimée J. P. M. Franssen, Juliette H. R. J. Degens, Karel W. E. Hulsewé, Yvonne L. J. Vissers, Erik R. de Loos","doi":"10.1111/crj.70016","DOIUrl":"https://doi.org/10.1111/crj.70016","url":null,"abstract":"<p>In a recent issue of <i>The Clinical Respiratory Journal</i>, Guo et al. published a study that evaluated the correlation between the rate and number of resected metastatic lymph nodes and survival in patients undergoing an anatomical resection for non–small cell lung cancer (NSCLC) [<span>1</span>]. To date, nodal staging is key in the work-up and treatment guidance for NSCLC as it is an important determinant of survival [<span>2, 3</span>]. As opposed to some other cancer types, nodal staging for lung cancer is based on the anatomic location of the respective regional and mediastinal lymph node stations rather than the number of metastasis [<span>4-6</span>]. Hence, the ongoing debate concerning the potential prognostic value of the number and rate of lymph node metastases in NSCLC continues. Over the last decade, numerous studies have aimed to address this issue [<span>7-10</span>]. However, they are generally limited by their retrospective design and inherent bias, as well as methodological disparity [<span>11</span>]. How does the current report add to the evidence collected for over more than a decade?</p><p>Guo et al. carried out the first population-based study concerning this subject. They revealed that both the number and rate of positive lymph nodes after lymphadenectomy concomitant to an anatomical lung parenchyma resection are a predictor for overall survival, independent of the anatomical location of the nodal station that is affected, being either N1 or N2. These results are in line with prior retrospective studies and a recently published meta-analysis [<span>8, 10, 12</span>]. However, the number and rate of metastatic lymph nodes was only examined in postoperative patients that underwent lymphadenectomy, in whom the lymph nodes were completely dissected (defined as examination of more than 15 dissected lymph nodes) instead of biopsied stations. Thus, these results are only applicable as a prognostic tool and in treatment decision-making processes for postoperative patients. To be of an even greater importance for treatment plan composition, for example, one should repeat this study for preoperative clinical lymph node staging (cTNM) using minimally invasive staging techniques like endosonographic lymph node staging (EUS/EBUS) or surgical video-assisted mediastinoscopy (VAM) or video-assisted mediastinoscopic lymphadenectomy (VAMLA). However, a recent publication showed in a noninferiority study that VAMLA might not be of added value in patients that underwent systemic EUS/EBUS [<span>13</span>]. Additionally, VAM/VAMLA or EUS is mainly used to assess N2 nodes. Hence, the vast majority of metastatic N1 nodes cannot be evaluated through these techniques. These drawbacks illustrate the challenges of the current TNM classification, and lymph node staging, especially for clinical lymph node staging. The sensitivity of preoperative lymph node staging modalities like (PET)-CT scan and EUS/EBUS ranges from 20% to 70%, resulting in a ","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"18 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}