Mediastinal lymph node removal ameliorates cytotoxic T-lymphocyte functions in patients with non-small cell lung cancer

2021 ◽  
pp. 030089162110646
Author(s):  
Ayse Engin ◽  
Akif Turna ◽  
Fehim Esen ◽  
Melek Agkoc ◽  
Duygu Ilke Cikman ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cell Death ◽  
Lymph Node ◽  
T Lymphocyte ◽  
Peripheral Blood ◽  
Cytotoxic T Lymphocyte ◽  
Mediastinal Lymph Node ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Death Protein

Introduction: Mediastinal lymph node (MLN) removal by video-assisted mediastinoscopic lymphadenectomy (VAMLA) for preoperative cancer staging was reported to be associated with increased survival. The aim of this study was to evaluate the immunologic effects of complete MLN removal by VAMLA on cytotoxic T lymphocyte (CTL) phenotype and function. Methods: Seventeen patients with non-small cell lung cancer (NSCLC) (stage cT1-4N0-3M0-1A) and 20 healthy participants were included in this study. Blood samples were collected before and 4 weeks after the procedure. Lymphocytes were isolated from the removed MLNs. CTL phenotypes and functions were evaluated by flow cytometry. Plasma levels of soluble programmed cell death protein 1 (sPD-1), soluble programmed cell death protein 1 ligand, and soluble CTL antigen 4 (sCTLA-4) were measured with enzyme-linked immunosorbent assay. Results: The ratio of the immunosenescent CTLs (CD3+CD8+CD28−) was increased in peripheral blood and MLNs of the patients with NSCLC compared to controls ( p = 0.037), and MLN removal did not change this ratio. PD-1 and CTL antigen 4 expressions were significantly reduced in peripheral blood CTLs after MLN removal by VAMLA ( p = 0.01 and p = 0.01, respectively). Granzyme A expression was significantly reduced in the peripheral blood CTLs of the patients compared to controls ( p = 0.006) and MLN removal by VAMLA significantly improved Granzyme A expression in CTLs ( p = 0.003). Plasma concentrations of sPD-1 and sCTLA-4 remained unchanged after VAMLA. Conclusion: CTLs in the MLNs and peripheral blood of the patients with NSCLC had an immunosenescent phenotype, increased immune checkpoint receptor expression, and impaired cytotoxicity. MLN removal by VAMLA improved these phenotypic and functional characteristics of CTLs. These changes may explain the potential contribution of VAMLA to improved survival.

Lung Cancer: Staging

Chest Imaging ◽  
2019 ◽  
pp. 281-287
Author(s):  
Ryo E. C. Benson
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Mediastinal Lymph Node ◽  
Tnm Classification ◽  
Cancer Staging ◽  
Tnm Staging ◽  
Small Cell ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Resected Tumor

Lung cancer staging is a process used to assess the extent of spread of lung cancer, determine the most appropriate treatment and predict the patient’s prognosis. Clinical staging is performed prior to surgical resection, while surgical-pathologic staging is based on histologic analysis of the resected tumor and lymph nodes. Restaging is performed following treatment. Staging is based on the TNM classification system. T refers to the primary tumor, N to thoracic lymph node involvement and M to metastatic disease. Recent changes to T and M descriptors were made to better reflect actual survival. For the majority of non-small cell lung cancers, the presence or absence of mediastinal lymph node spread is the most important outcome predictor. Although no changes were made to the N descriptor, the actual intrathoracic lymph node stations were recently clarified. Although the majority of small cell lung cancers are metastatic at the time of presentation, the presence of limited versus extensive spread of disease determines treatment options. However, the overall prognosis and survival for affected patients is poor. TNM staging is now recommended for carcinoid tumors as well as small cell lung cancer.

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