Prediction of Mediastinal Station IV Lymph Node Metastasis in Non-small Cell Lung Cancer

Mediastinal lymph node metastasis is a common metastasis pathway of non-small cell lung cancer (NSCLC), and its occurrence is closely related to the lymphatic drainage pattern, which is different in different pulmonary lobe NSCLC, which poses a challenge for the formulation of individualized treatment strategies. Accurate staging is the prerequisite for accurate treatment of NSCLC. Computed Tomograph (CT) examination is an important tool for evaluating mediastinal lymph node metastasis, which is crucial for making treatment plan and evaluating patient prognosis. However, it is difficult to diagnose metastatic lymph nodes with insignificant imaging features. Especially metastatic lymph nodes in areas 4 and 7. Both zone 4 and zone 7 are hot spots for mediastinal lymph node metastasis. However, clinical guidelines do not make clear provisions on lymph node dissection in zone 4, which makes preoperative clinical staging and prognosis evaluation of patients with NSCLC particularly important. By integrating and analyzing a large amount of data in CT images, the newly emerging CT radiomics technology captures subtle features that may be overlooked in conventional CT scans, showing great application prospects in the accuracy of non-invasive diagnosis of lymph node metastasis. This study aims to explore the mediastinal drainage pattern and the role of CT in evaluating mediastinal lymph node metastasis, in order to provide valuable imaging evidence for accurately judging mediastinal lymph node metastasis of NSCLC, formulating appropriate lymph node dissection scope, optimizing treatment strategy, and improving patient prognosis.

Sex

All

Inclusion Criteria:

1. Surgical resection and systematic lymph node dissection were performed in the department of thoracic surgery, and the postoperative pathological findings were confirmed as NSCLC and complete pathological diagnostic data were retained.
2. Chest CT enhancement scan was completed within 2 weeks prior to surgery
3. Image quality meets analysis standards and clinical data is complete.
4. Lymph nodes that were pathologically confirmed to be metastatic or non-metastatic at station 4 were selected

Exclusion Criteria:

1. Preoperative chemoradiotherapy or other treatment
2. Distant metastasis or other malignant tumors are present
3. Incomplete clinical data or image artifacts
4. No metastatic or non-metastatic lymph nodes were found at station 4

• BACKGROUNDSiegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023 Jan;73(1):17-48. doi: 10.3322/caac.21763. PMID 36633525
• BACKGROUNDTakano N, Ariyasu R, Koyama J, Sonoda T, Saiki M, Kawashima Y, Oguri T, Hisakane K, Uchibori K, Nishikawa S, Kitazono S, Yanagitani N, Ohyanagi F, Horiike A, Gemma A, Nishio M. Improvement in the survival of patients with stage IV non-small-cell lung cancer: Experience in a single institutional 1995-2017. Lung Cancer. 2019 May;131:69-77. doi: 10.1016/j.lungcan.2019.03.008. Epub 2019 Mar 21. PMID 31027701
• BACKGROUNDZhou D, Yue D, Zhang Z, Tian P, Feng Y, Liu Z, Zhang B, Wang M, Zhao X, Wang C. Prognostic significance of 4R lymph node dissection in patients with right primary non-small cell lung cancer. World J Surg Oncol. 2022 Jul 1;20(1):222. doi: 10.1186/s12957-022-02689-w. PMID 35778770
• BACKGROUNDShamji FM, Beauchamp G, Sekhon HJS. The Lymphatic Spread of Lung Cancer: An Investigation of the Anatomy of the Lymphatic Drainage of the Lungs and Preoperative Mediastinal Staging. Thorac Surg Clin. 2021 Nov;31(4):429-440. doi: 10.1016/j.thorsurg.2021.07.005. PMID 34696855
• BACKGROUNDHanaoka J, Yoden M, Okamoto K, Kaku R, Ohshio Y. Mediastinal lymph node evaluation, especially at station 4L, in left upper lobe lung cancer. J Thorac Dis. 2022 Sep;14(9):3321-3334. doi: 10.21037/jtd-22-537. PMID 36245624
• BACKGROUNDMascalchi M, Zompatori M. Mediastinal Lymphadenopathy in Lung Cancer Screening: A Red Flag. Radiology. 2022 Mar;302(3):695-696. doi: 10.1148/radiol.212501. Epub 2021 Nov 23. No abstract available. PMID 34812678
• BACKGROUNDYoshida Y, Saeki N, Yotsukura M, Nakagawa K, Watanabe H, Yatabe Y, Watanabe SI. Visualization of patterns of lymph node metastases in non-small cell lung cancer using network analysis. JTCVS Open. 2022 Oct 13;12:410-425. doi: 10.1016/j.xjon.2022.10.003. eCollection 2022 Dec.