- Resource Type:
PS73. The Oncologic Significance of Station 9 Nodes During Lobectomies
May 6, 2023
103rd Annual Meeting, the Los Angeles Convention Center, Los Angeles, CA, USA
Los Angeles Convention Center, Outside of Room 408
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.
Anupama Singh (1), Rafael Barcelos (1), Michael Jaklitsch (1), Paula Ugalde Figueroa (1), Fatima Wilder (1), (1) Brigham and Women's Hospital, Boston, MA
I am a general surgery resident at UMass Memorial Medical Center. I have completed two years thus far and am interested in cardiothoracic surgery. I'm currently in my first year of research and am a thoracic oncology research fellow at Brigham and Women's Hospital working primarily with Dr. Michael Jaklitsch. Our focus is on clinical outcomes in thoracic oncology. We also specialize in outcomes of elderly patients and collaborate routinely with the Division of Aging. In addition to clinic outcomes work, I have prior experience in basic science research in cardiovascular and reproductive health.