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NCT Number: NCT07801430

Station 4L Lymph Node Dissection Versus No Dissection in Clinical Stage I Solid Nodule-Type Invasive NSCLC

This multicenter, prospective, randomized clinical trial will enroll adults aged 18 to 75 years with resectable clinical stage I (T1-T2aN0M0) invasive non-small cell lung cancer presenting as a single solid nodule (consolidation-to-tumor ratio 1.0) in the left lung. After intraoperative frozen-section confirmation of invasive non-small cell lung cancer and completion of standard lung resection and systematic mediastinal lymph node dissection, participants will be randomly assigned 1:1 either to undergo station 4L lymph node dissection or to omit station 4L dissection. The primary hypothesis is that omitting station 4L dissection is noninferior to performing it with respect to 3-year disease-free survival. Secondary outcomes include 3-year overall survival, perioperative complications, 90-day mortality, and station 4L nodal metastasis.

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Key information

Conditions

Non-small Cell Lung Cancer Bronchial Neoplasms Carcinoma, Bronchogenic Carcinoma, Non-Small-Cell Lung Lung Diseases Lung Neoplasms Neoplasms Neoplasms by Site Respiratory Tract Diseases Respiratory Tract Neoplasms Thoracic Neoplasms

Age range

18 year–75 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Fudan University Shanghai Cancer Center

Shanghai, Xuhui, 200000, China

Location status: Recruiting

Location contact

Yang Zhang, MD

CONTACT

[email protected]

86-18717722753

About this study

Station 4L lymph nodes are located in a technically challenging area near the aortic arch, left pulmonary artery, thoracic duct, and left recurrent laryngeal nerve. Dissection may improve nodal staging but may also increase operative complexity and complications. This study will evaluate whether station 4L dissection can be omitted without compromising long-term outcomes in patients with early-stage left-sided invasive non-small cell lung cancer.

Eligible participants will undergo complete resection by segmentectomy or lobectomy and systematic mediastinal lymph node dissection. After intraoperative frozen-section confirmation of invasive non-small cell lung cancer, participants will be randomized in a 1:1 ratio to station 4L lymph node dissection or no station 4L dissection. Randomization is stratified by tumor lobe. The planned enrollment is 384 participants, including 258 with left upper lobe tumors and 126 with left lower lobe tumors.

Participants will be followed every 6 months for 3 years after surgery. The primary comparison is 3-year disease-free survival. Secondary assessments include 3-year overall survival, surgery-related complications within 30 days, all-cause mortality within 90 days, and the frequency of station 4L nodal metastasis among participants assigned to station 4L dissection.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age 18 to 75 years.
  • A single solid pulmonary nodule (consolidation-to-tumor ratio of 1.0) located in the left lung.
  • Resectable clinical stage I (T1-T2aN0M0) non-small cell lung cancer, with a maximum tumor diameter of 4 cm or less, evaluated by positron emission tomography/computed tomography.
  • Planned complete lung resection by segmentectomy or lobectomy with systematic mediastinal lymph node dissection.
  • Intraoperative frozen-section pathological confirmation of invasive non-small cell lung cancer before randomization.
  • Able to provide written informed consent and willing to complete the protocol-specified follow-up.

Exclusion criteria

  • Intraoperative or postoperative pathology indicates noninvasive non-small cell lung cancer.
  • Surgical procedure other than segmentectomy or lobectomy.
  • Incomplete tumor resection or residual tumor.
  • History of another malignant tumor.
  • History of previous lung surgery.
  • Previous radiotherapy or chemotherapy for the current lung cancer.

Treatment and study plan

Station 4L Lymph Node Dissection

Procedure

During complete lung resection and systematic mediastinal lymph node dissection, all lymphatic and fatty tissue in the station 4L region is surgically removed and submitted for pathological examination. Other mediastinal stations are dissected according to the study protocol in both arms.

Primary outcomes

  1. 3-Year Disease-Free Survival

    Time frame: From enrollment to 3 years

    Proportion of participants alive without disease recurrence. A disease-free survival event is the first documented recurrence of non-small cell lung cancer or death from any cause.

Secondary outcomes

  1. 3-Year Overall Survival

    Time frame: From enrollment to 3 years

    Proportion of participants alive 3 years after enrollment. Death from any cause is counted as an event.

  2. 30-Day Surgery-Related Complication Rate

    Time frame: From surgery through postoperative day 30

    Proportion of participants with at least one surgery-related complication, graded according to Common Terminology Criteria for Adverse Events version 3.0.

  3. 90-Day All-Cause Mortality

    Time frame: From surgery through postoperative day 90

    Proportion of participants who die from any cause within 90 days after surgery.

  4. Station 4L Lymph Node Metastasis Rate

    Time frame: At postoperative pathological assessment, up to 30 days after surgery

    Among participants assigned to station 4L lymph node dissection, the proportion with pathologically confirmed metastasis in resected station 4L lymph nodes.

Sponsors and collaborators

Lead sponsor

Fudan University

Other

Registry information

Official study title

A Multicenter Prospective Randomized Controlled Trial of Station 4L Lymph Node Dissection Versus No Dissection in Clinical Stage I Solid Nodule-Type Invasive Non-Small Cell Lung Cancer

Important dates

Study start
2025
Primary completion
2028
Study completion
2030
First posted
Sep 3, 2026
Registry last updated
Sep 3, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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