Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis Shun-ichi Watanabe, MD, Kenji Suzuki,

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Superior and Basal Segment Lung Cancers in the Lower Lobe Have Different Lymph Node Metastatic Pathways and Prognosis Shun-ichi Watanabe, MD, Kenji Suzuki, MD, Hisao Asamura, MD The Annals of Thoracic Surgery Volume 85, Issue 3, Pages 1026-1031 (March 2008) DOI: 10.1016/j.athoracsur.2007.10.076 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Survival of patients with pN2 tumors located in the basal and superior segment of the lower lobe. The 5-year survival was 32.9% for the basal segment group (black line) and 19.9% for the superior segment group (gray line), but the difference was not significant (p = 0.1308). The Annals of Thoracic Surgery 2008 85, 1026-1031DOI: (10.1016/j.athoracsur.2007.10.076) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Survival of patients with lower lobe pN2 tumors with and without superior mediastinal metastasis in tumors with (A) basal segment origin and (B) superior segment origin. (A) In the basal segment group, the patients without superior mediastinal metastasis (black line) showed significantly better prognosis than did those with (grey line) superior mediastinal metastasis (5-year survival, 42.7% vs 15.6%, p = 0.0453). (B) Survival of patients with superior segment pN2 tumors grouped by the extent of lymph node metastasis. No significant differences in survival were detected between patients without superior mediastinal metastasis (black line; 5-year survival, 25.4%) and with superior mediastinal metastasis (5-year survival, 16.5%: with only superior mediastinal node metastasis (dark gray line, 20.0%; with superior mediastinal and subcarinal metastasis, light gray line, 10.3%; p = 0.1623). The Annals of Thoracic Surgery 2008 85, 1026-1031DOI: (10.1016/j.athoracsur.2007.10.076) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The scheme of the main stream of lymphatic spread of the tumor in each segment. (A) Basal segment tumor metastasizes to the superior mediastinum mostly through the subcarinal node. (B) Superior segment tumor often metastasizes directly to the superior mediastinum, without concomitant metastasis to the subcarinal node. The Annals of Thoracic Surgery 2008 85, 1026-1031DOI: (10.1016/j.athoracsur.2007.10.076) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions