General Thoracic and Cardiovascular Surgery

, Volume 65, Issue 11, pp 640–645 | Cite as

Predictors for hilar/intrapulmonary lymph node metastasis in discrete type of clinical N1 non-small cell lung cancer

  • Takayuki Fukui
  • Katsuhiko Kato
  • Toshiki Okasaka
  • Koji Kawaguchi
  • Koichi Fukumoto
  • Shota Nakamura
  • Shuhei Hakiri
  • Naoki Ozeki
  • Kohei Yokoi
Original Article



Accurate preoperative evaluation of lymph nodes can provide optimal treatment for patients. However, in patients with clinical N1 disease (cN1) non-small cell lung cancer (NSCLC), no suitable predictor has been identified for hilar/intrapulmonary lymph node metastasis (pathological N1 disease; pN1). The purpose of this study was to identify pN1 in cN1 NSCLC patients.


We retrospectively reviewed the clinicoradiological features of 109 patients with a discrete type of cN1 NSCLC who had undergone complete resection at our institution from 2004 to 2015. The association between clinicoradiological variables and nodal status was analyzed to identify predictors for pN1.


The cohort consisted of 77 males and 32 females, ranging in age from 39 to 84 years. The breakdown by pathological N category was 40 (37%) pN0, 41 (38%) pN1, and 28 (25%) pN2 patients. Maximum lymph node diameter was identified as a significant predictor for pN1, with an odds ratio of 1.25 (P = 0.010). When limited to 63 patients who underwent positron emission tomography (FDG-PET) at our institution, the maximum standardized uptake value (SUVmax) of the lymph node was an independent predictor, with an odds ratio of 1.91 with logistic regression analysis (P = 0.004). The size of lymph node and the SUVmax were significant factors for pN1, with optimal cut-off values of 13 mm and 4.28, respectively.


Among the patients with cN1, maximum lymph node size and SUVmax of the FDG-PET were significant predictors for pN1.


Non-small cell lung cancer N1 Computed tomography Positron emission tomography 


Compliance with ethical standards


This work was not supported by any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors have declared that no conflict of interest exists.


  1. 1.
    Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours (Uicc International Union Against Cancer). Geneva: Wiley-Blackwell; 2009.Google Scholar
  2. 2.
    Rusch VW, Crowley J, Giroux DJ, Goldstraw P, Im JG, Tsuboi M, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:603–12.CrossRefPubMedGoogle Scholar
  3. 3.
    Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest. 1997;111:1718–23.CrossRefPubMedGoogle Scholar
  4. 4.
    de Langen AJ, Raijmakers P, Riphagen I, Paul MA, Hoekstra OS. The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis. Eur J Cardiothorac Surg. 2006;29:26–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Lewis JW Jr, Pearlberg JL, Beute GH, Alpern M, Kvale PA, Gross BH, et al. Can computed tomography of the chest stage lung cancer? Yes and no. Ann Thorac Surg. 1990;49:591–5 (discussion 5–6).CrossRefPubMedGoogle Scholar
  6. 6.
    Izbicki JR, Thetter O, Karg O, Kreusser T, Passlick B, Trupka A, et al. Accuracy of computed tomographic scan and surgical assessment for staging of bronchial carcinoma. A prospective study. J Thorac Cardiovasc Surg. 1992;104:413–20.PubMedGoogle Scholar
  7. 7.
    Bille A, Pelosi E, Skanjeti A, Arena V, Errico L, Borasio P, et al. Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography. Eur J Cardiothorac Surg. 2009;36:440–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Hishida T, Yoshida J, Nishimura M, Nishiwaki Y, Nagai K. Problems in the current diagnostic standards of clinical N1 non-small cell lung cancer. Thorax. 2008;63:526–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Kim D, Choi YS, Kim HK, Kim K, Kim J, Shim YM. Heterogeneity of clinical n1 non-small cell lung cancer. Thorac Cardiovasc Surg. 2014;62:103–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Sawabata N, Miyaoka E, Asamura H, Nakanishi Y, Eguchi K, Mori M, et al. Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade. J Thorac Oncol. 2011;6:1229–35.CrossRefPubMedGoogle Scholar
  11. 11.
    Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC, editors. Pathology and genetics of tumors of the lung, pleura, thymus and heart. In: WHO Classification of tumors, 2nd edn. Lyon: IARC Press; 2004. p. 145–97.Google Scholar
  12. 12.
    Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P, et al. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:568–77.CrossRefPubMedGoogle Scholar
  13. 13.
    Watanabe S, Asamura H, Suzuki K, Tsuchiya R. Problems in diagnosis and surgical management of clinical N1 non-small cell lung cancer. Ann Thorac Surg. 2005;79:1682–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Rice D, Chansky K, Nowak A, Pass H, Kindler H, Shemanski L, et al. The IASLC mesothelioma staging project: proposals for revisions of the N descriptors in the forthcoming eighth edition of the TNM classification for pleural mesothelioma. J Thorac Oncol. 2016;11:2100–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Nakao M, Yoshida J, Ishii G, Kawase A, Maeda R, Aokage K, et al. Prognostic impact of node involvement pattern in pN1 non-small cell lung cancer patients. J Thorac Oncol. 2010;5:1576–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Marra A, Hillejan L, Zaboura G, Fujimoto T, Greschuchna D, Stamatis G. Pathologic N1 non-small cell lung cancer: correlation between pattern of lymphatic spread and prognosis. J Thorac Cardiovasc Surg. 2003;125:543–53.CrossRefPubMedGoogle Scholar
  17. 17.
    van Velzen E, Snijder RJ, Brutel de la Riviere A, Elbers HJ, van den Bosch JM. Type of lymph node involvement influences survival rates in T1N1M0 non-small cell lung carcinoma. Lymph node involvement by direct extension compared with lobar and hilar node metastases. Chest. 1996;110:1469–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e211S–50S.CrossRefPubMedGoogle Scholar
  19. 19.
    Shimoyama K, Murata K, Takahashi M, Morita R. Pulmonary hilar lymph node metastases from lung cancer: evaluation based on morphology at thin-section, incremental, dynamic CT. Radiology. 1997;203:187–95.CrossRefPubMedGoogle Scholar
  20. 20.
    Miyoshi K, Mimura T, Iwanaga K, Adachi S, Tsubota N, Okada M. Surgical treatment of clinical N1 non-small cell lung cancer: ongoing controversy over diagnosis and prognosis. Surg Today. 2010;40:428–32.CrossRefPubMedGoogle Scholar
  21. 21.
    Ettinger DS, Wood DE, Akerley W, Bazhenova LA, Borghaei H, Camidge DR, et al. Non-small cell lung cancer, version 6.2015. J Natl Compr Cancer Netw. 2015;13:515–24.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2017

Authors and Affiliations

  • Takayuki Fukui
    • 1
  • Katsuhiko Kato
    • 2
  • Toshiki Okasaka
    • 1
  • Koji Kawaguchi
    • 1
  • Koichi Fukumoto
    • 1
  • Shota Nakamura
    • 1
  • Shuhei Hakiri
    • 1
  • Naoki Ozeki
    • 1
  • Kohei Yokoi
    • 1
  1. 1.Department of Thoracic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Radiological and Medical Laboratory SciencesNagoya University Graduate School of MedicineNagoyaJapan

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