Work

Regularity and correlation analysis of regional lymph node metastasis in nonoperative patients with non-small cell lung cancer based on positron emission tomography/computed tomography images

Year: 2024

Type: article

Abstract: Background and purpose: Non-small cell lung cancer (NSCLC) lymphatic metastasis mechanism in postoperative patients was previously investigated. However, surgery disrupts the natural lymphatic drainage pathway. Moreover, inherent metastatic patterns and its correlation with regional lymph node levels in patients with NSCLC remains unknown. We aimed to analyze the metastasis regularities and establish the correlations between different lymph node levels in 358 patients with NSCLC without any intervention using positron emission tomography/computed tomography (PET/CT) images. This study was also to provide preliminary theoretical recommendations for the delineation of clinical target volume in radiotherapy for NSCLC, particularly in definitive radiotherapy. Materials and methods: Overall, 358 patients with N1–N3 NSCLC admitted in our hospital between 2018 to 2022 and 1,852 radiologically metastatic lymph node levels were retrospectively analyzed. The diagnosis of metastatic lymph nodes was reviewed and determined using the European Organization for Research and Treatment of Cancer standard and the standardized value of the PET/CT examination. The 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (TNM) staging system was used for tumor staging. Regional lymph nodes in patients with NSCLC were classified according to the 2009 International Association for the Study of Lung Cancer Staging Project. The correlations between the different levels were evaluated using the chi-square test and logistic regression model. Results: The lymph nodes with the highest metastasis rates were 10L, 4L, 5, 4R, and 7 in patients with left lung cancer and 10R, 4R, 7, 2R, and 1R in those with right lung cancer. The left lung cancer group demonstrated a greater likelihood of contralateral hilus, mediastinum, and supraclavicular lymph node involvement; the right lung cancer group exhibited a higher propensity for ipsilateral mediastinum and supraclavicular lymph node invasion. The correlation analysis of metastatic lymph nodes in the left lung cancer showed that 1L correlated with 1R, 2L, and 4L, while 1R correlated with 1L, 2R, and 4L. Similarly, 2L correlated with 1L and 1R, while 2R correlated with 1R, 4L, and 8. 3a correlated with 6, while 3p was not associated with other levels. Furthermore, 4L correlated with 1L, 1R, and 4R, and 4R with 4L, 7, and 10R. 5 showed a correlation with 6. 6 was associated with 3a and 5, while 7 was associated with 4L, 4R, 8, 9, and 10L. 8 was associated with 2R and 7. 9 was correlated with 7, 10L with 7, and 10R with 4R. A correlation analysis of metastatic lymph nodes in patients with right lung cancer showed that IL was associated with 1R, 3a, 4L, and 6. Moreover, 1R correlated with 2R, while 2L correlated with 5 and 6. Additionally, 2R correlated with 1R, 3a, and 4R. 3a correlated with 2R; 3p with 6; 4L with 1L, 4R, 5, and 7; and 4R with 2R and 4L. Furthermore, 5 correlated with 2L, 4L, and 10L; 6 with 1L, 2L, and 3p; 7 with 4L and 8; 8 with 5 and 9; 9 with 8; and 10L with 5. No correlation was found between 10R and other levels. All P-values were <0.05. Conclusion: This study elucidated the patterns of primary lymph node metastasis in patients with NSCLC who had not undergone surgery (without any treatment interventions) and the correlations between lymph node levels. These findings could improve limited recommendations for target volume delineation in definitive or postoperative radio

Source: Radiation Oncology

DOI: 10.1186/s13014-024-02523-5