Comparative Effectiveness of a Lymph Node Collection Kit Versus Heightened Awareness on Lung Cancer Surgery Quality and Outcomes

Ray, Meredith; Fehnel, Carrie; Akinbobola, Olawale; Faris, Nicholas R.; Taylor, Meghan; Pacheco, Alicia; Smeltzer, Matthew; Osarogiagbon, Raymond U.

doi:10.1016/j.jtho.2021.01.1618

Cited by 11 publications

(8 citation statements)

References 33 publications

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“…Finally, this analysis examined process outcomes, including delivery of surgery and adjuvant chemotherapy, rather than clinical outcomes, such as survival. Still, associations between these process metrics and clinical outcomes have been described previously, and these associations will be examined as part of a planned survival analysis of the overall ALCHEMIST trial once there is a sufficient number of events.…”

Section: Discussionmentioning

confidence: 99%

Rates of Guideline-Concordant Surgery and Adjuvant Chemotherapy Among Patients With Early-Stage Lung Cancer in the US ALCHEMIST Study (Alliance A151216)

et al. 2022

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IMPORTANCEStandard treatment for resectable non-small cell lung cancer (NSCLC) includes anatomic resection with adequate lymph node dissection and adjuvant chemotherapy for appropriate patients. Historically, many patients with early-stage NSCLC have not received such treatment, which may affect the interpretation of the results of adjuvant therapy trials.OBJECTIVE To ascertain patterns of guideline-concordant treatment among patients enrolled in a US-wide screening protocol for adjuvant treatment trials for resected NSCLC. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 2833 patients with stage IB to IIIA NSCLC (per American Joint Committee on Cancer 7th edition criteria) who enrolled in the Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST) screening study (Alliance for Clinical Trials in Oncology A151216) from August 18, 2014, to April 1, 2019, and who did not enroll in a therapeutic adjuvant clinical trial; patients had tumors of at least 4 cm and/or with positive lymph nodes. Statistical analysis was conducted from June 1, 2020, through October 1, 2021. EXPOSURES Care patterns were ascertained overall and by sociodemographic and clinical factors, including age, sex, race and ethnicity, educational level, marital status, geography, histologic characteristics, stage, genomic variant status, smoking history, and comorbidities. MAIN OUTCOMES AND MEASURESFive outcomes are reported: whether patients (1) had anatomic surgical resection, (2) had adequate lymph node dissection (Ն1 N1 nodal station plus Ն3 N2 nodal stations), (3) received any adjuvant chemotherapy, (4) received any cisplatin-based adjuvant chemotherapy, and (5) received at least 4 cycles of adjuvant chemotherapy. RESULTSOf the 2833 patients (1505 women [53%]; mean [SD] age, 66.5 [9.2] years) included in this analysis, 2697 (95%) had anatomic surgical resection, 1513 (53%) had adequate lymph node dissection, 1617 (57%) received any adjuvant chemotherapy, 1237 (44%) received at least 4 cycles of adjuvant platinum-based chemotherapy, and 965 (34%) received any cisplatin-based adjuvant chemotherapy. Rates were similar across race and ethnicity.CONCLUSIONS AND RELEVANCE This cohort study found that among participants in a screening protocol for adjuvant clinical trials for resected early-stage NSCLC, just 53% underwent adequate lymph node dissection, and 57% received adjuvant chemotherapy, despite indications for such treatment. These results may affect the interpretation of adjuvant trials. Efforts are needed to optimize the use of proven therapies for early-stage NSCLC.

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Section: Discussionmentioning

confidence: 99%

Rates of Guideline-Concordant Surgery and Adjuvant Chemotherapy Among Patients With Early-Stage Lung Cancer in the US ALCHEMIST Study (Alliance A151216)

et al. 2022

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“…Precise evaluation of the quality of resection should be implemented as it ensures an accurate interpretation of outcomes in clinical trials evaluating any type of adjuvant therapy including PORT. [21][22][23] A lymph node collection kit could help improving surgical quality outcomes in the future. 23…”

Section: Surgical Quality Resectionmentioning

confidence: 99%

“…[21][22][23] A lymph node collection kit could help improving surgical quality outcomes in the future. 23…”

Section: Surgical Quality Resectionmentioning

confidence: 99%

“…5,[25][26][27] Quality of surgery, and more particularly evaluation of nodal exploration, is of outmost importance as developed previously. 20,21,23 In the Lung ART trial, careful review of surgical and pathologic reports of these complete resections demonstrated that complete R0 resection according to IASLC definition was confirmed only in 29% of patients. 22,28 Quality of surgery has not yet been reported in the PORT-C trial, but an exploratory analysis showed a DFS benefit after stratification according to the number of detected and positive lymph nodes (HR, 0.75; 95% CI, 0.58 to 0.98; twosided log-rank P 5 .04).…”

Section: High-risk N2 Populationmentioning

confidence: 99%

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Indications and Parameters Around Postoperative Radiation Therapy for Lung Cancer

Lévy

Mercier

Péchoux

2022

JCO

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Patients with locally advanced resected non–small-cell lung cancer present a high risk of relapse. Although adjuvant platinum–based chemotherapy has become the standard of care, the role of postoperative radiation therapy (PORT) has been controversial for years. In patients with incomplete resection, PORT should be proposed, on the basis of a strong consensus, despite the absence of randomized evidence. In patients with completely resected (R0) non–small-cell lung cancer, a meta-analysis showed poorer outcomes after PORT in the absence of mediastinal involvement (pN0 and pN1). In patients with pN2, the role of PORT was less clear and required further research. The meta-analysis included trials using older radiation techniques and poorer quality of surgery according to today's standards, and selection of patients was not positron emission tomography–based. Newer retrospective and nonrandomized studies and subgroup analyses of randomized trials evaluating adjuvant chemotherapy suggested a survival benefit of PORT in patients with pN2 R0. Two recent randomized trials (Lung ART and PORT-C) evaluating conformal PORT versus no PORT retrieved no disease-free survival advantage for stage IIIA-N2 patients, even if mediastinal relapse was significantly decreased with PORT. PORT had no effect on survival, possibly given the high rate of distant relapse and risk of additional cardiopulmonary toxicity. Ongoing and future analyses are planned in Lung ART to identify patients for whom PORT could be recommended. Incorporation of newer systemic treatments (immune checkpoint inhibitors or targeted therapy in oncogene-addicted patients) is underway in the neoadjuvant and/or adjuvant setting. Better identification of patients at a high risk of disease recurrence, with analysis of circulating tumor DNA, on the basis of the detection of postsurgical minimal (or molecular) residual disease is warranted in future studies.

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“…In a follow up study, heightened awareness was added as a measure to improve suboptimal lymph node evaluation, and although it did result in increased quality of surgical resection and pathological assessment, use of a specimen collection kit was the most effective tool (33).…”

Section: Future Directionmentioning

confidence: 99%

Evaluating the quality of lymphadenectomy in lung cancer resections: a narrative review

Kakuturu¹,

Abbas²,

Toker³

2022

AME Surg J

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Objective: To review the current guidelines on intrathoracic lymph node assessment for lung cancer resections, examine current practice patterns, report survival differences with varying levels of lymph node dissection, and propose methods to improve quality of lymphadenectomy based on our experience.Background: Assessment of hilar and mediastinal lymph nodes at the time of resection for lung cancer has been recognized as a key aspect of surgical treatment. Although the value of lymphadenectomy in lung cancer staging and treatment has been established, specific guidelines as to the number and location of lymph nodes considered to be adequate, vary among societies, institutions, and surgeons. Additionally, many lung resections fail to meet any of the proposed criteria for lymph node examination.Methods: To find relevant articles for the narrative review, the PubMed database was used to search for the following key terms and their combinations: "lymphadenectomy", "lymph node staging", "lung cancer", "NSCLC", "lung surgery", "lung resection", "lobectomy", "segmentectomy", "wedge resection", "quality", and "extent". A total of 33 articles were examined and publication years ranged from 1951 to 2021.Conclusions: Systematic mediastinal lymph node dissection is recommended in all type of surgeries for lung cancer, whether robotic surgery, video-assisted thoracoscopic surgery (VATS), or an open thoracotomy.There should be no difference in each technique as to the number of stations and quantity of lymph nodes examined, in order for lung cancer resection to be considered complete.

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Comparative Effectiveness of a Lymph Node Collection Kit Versus Heightened Awareness on Lung Cancer Surgery Quality and Outcomes

Cited by 11 publications

References 33 publications

Rates of Guideline-Concordant Surgery and Adjuvant Chemotherapy Among Patients With Early-Stage Lung Cancer in the US ALCHEMIST Study (Alliance A151216)

Rates of Guideline-Concordant Surgery and Adjuvant Chemotherapy Among Patients With Early-Stage Lung Cancer in the US ALCHEMIST Study (Alliance A151216)

Indications and Parameters Around Postoperative Radiation Therapy for Lung Cancer

Evaluating the quality of lymphadenectomy in lung cancer resections: a narrative review

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