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J Thorac Dis. 2018 Dec;10(12):6803-6810. doi: 10.21037/jtd.2018.11.31.

The impact on mediastinal recurrence based on the number of harvested mediastinal lymph nodes and assessed N2 Stations in patients with stage I invasive lung adenocarcinoma.

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Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.



To determine the impact of the number of harvested mediastinal lymph nodes (MLNs) and assessed N2 stations on the mediastinal recurrence for pathologic stage I invasive lung adenocarcinoma (IADC).


A total of 2,048 patients with stage I IADC undergoing surgical resection were enrolled at Shanghai Chest Hospital from 2009 to 2013. Survival analysis was performed by Kaplan-Meier method along with univariable and multivariable cox regression analysis.


For patients with ≥5 MLNs, mediastinum-specific relapse-free survival (MS-RFS) rates were 98.3% and 96.6% for 3- and 5-year, respectively, which significantly demonstrated better survival outcomes against those with <5 MLNs (96.3% and 92.8%, respectively, log-rank P=0.018). Additionally, the 3- and 5-year RFS of patients with assessed N2 stations ≥3 (98.2% and 95.8%) were exceptionally better when compared with those with N2 stations <3 (95.5%, 90.3%, log-rank P<0.001). In the univariable and multivariable cox analyses, we found that the number of assessed N2 stations was an independent predictor to MS-RFS (HR =0.468; 95% CI, 0.312-0.867; P=0.020) as opposed to the number of harvested MLNs (HR =0.856; 95% CI, 0.423-1.489; P=0.543) which was not a predictor.


Based on our results, we recommend, for a better MS-RFS among patients with pathological stage I IADC, that the cutoff values for harvested MLNs and assessed N2 stations be 5 and 3, respectively. In addition, the number of assessed N2 stations was still an independent predictor to MS-RFS.


Harvested mediastinal lymph nodes; assessed N2 stations; mediastinum-specific relapse-free survival (MS-RFS); pathologic stage I invasive lung adenocarcinoma

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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