Size and extranodal extension of metastatic lymph nodes in lung adenocarcinoma

Duk Hwan Moon, Jin Ho Choi, Hee Chul Yang, Moon Soo Kim, Jong Mog Lee, Geon Kook Lee, Jae Hyun Jeon

Research output: Contribution to journalArticlepeer-review


Background: This study assessed the prognostic significance of metastatic lymph node size (MLNS) and extranodal extension (EN) in patients with node-positive lung adenocarcinoma (ADC). Methods: Prognostic factors influencing survival were analyzed, including age, sex, extent of operation, T- and N-stage, size of tumor, postoperative chemotherapy, presence of EN, and MLNS (>7.0 vs. ≤7.0 mm). Results: Three hundred seventy-five patients met the inclusion criteria were enrolled (mean age: 59.8±10.5 years). Increasing MLNS was significantly correlated with large tumor size (P=0.015), advanced N status (P<0.001), and presence of EN (P<0.001). In multivariable analysis, large tumor size [hazard ratio (HR) 1.135, 95% confidence interval (CI): 1.050 to 1.228, P<0.001], adjuvant chemotherapy (HR 0.582, 95% CI: 0.430 to 0.787, P<0.001), EN (HR 1.454, 95% CI: 1.029 to 2.055, P=0.034), and MLNS greater than 7 mm (HR 1.741, 95% CI: 1.238 to 2.447, P<0.001) were significant prognostic factors for survival. Patients were classified into 3 groups: Group A, MLNS ≤7.0 mm/EN (−); Group B, MLNS ≤7.0 mm/EN (+) or MLNS >7.0 mm/EN (−); and Group C, MLNS >7.0 mm/EN (+). The 5-year overall survival (OS) was 72.2%, 59.0%, and 38.5% in Groups A, B and C, respectively (P<0.001). Conclusions: The MLNS and presence of EN could provide an important prognostic implication for patients with node-positive lung ADC.

Original languageEnglish
Pages (from-to)6514-6522
Number of pages9
JournalJournal of Thoracic Disease
Issue number11
StatePublished - Nov 2020
Externally publishedYes


  • Follow-up
  • Lung adenocarcinoma
  • Lymph node metastasis
  • Surgery

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