Extent of lymphadenectomy and outcome for patients with stage I nonsmall cell lung cancer

Varlotto, John M.; Recht, Abram; Nikolov, M.; Flickinger, John C.; DeCamp, Malcolm M.

doi:10.1002/cncr.23985

Cited by 120 publications

(109 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Overall , 40 % had one positive LN, 35% had two to three positive LNs, 21% had four to eight positive LNs, and 4% had more than eight positive LNs. The median (interquartile range) of the number of LNs sampled was 14 (12)(13)(14)(15)(16)(17)(18)(19). The baseline characteristics of patients in the four LN groups are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…14,[25][26][27][28] Although the LN ratio may be applied among patients with a low number of LNs sampled, current data suggest that staging based on , 10 LNs is not accurate. [15][16][17][18][19] Additionally, the number of positive LNs is a more direct and intuitive measure of the extent of LN involvement, and thus may be more readily adapted into clinical practice. Although the number of positive nodes and the LN ratio have shown to be valid prognostic factors of N1 NSCLC, both measures are sensitive to the total number of LNs evaluated during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Thus, in order to adequately estimate the extent of LN involvement, we restricted our analysis to patients who underwent sampling of Ն 10 regional LNs during surgery (the recommended extent of LN dissection in the literature). [15][16][17][18][19] Sociodemographic characteristics (age, sex, race/ethnicity, and marital status) were obtained from the SEER registry. Cases were staged according to the seventh edition of the TNM classifi cation using SEER data on tumor extension, LN involvement, and systemic metastasis.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer

Jonnalagadda

Smith

Mhango

et al. 2011

Chest

View full text Add to dashboard Cite

Lung cancer is the leading cause of cancer mortality for both men and women in the United States. 1 The overall 5-year survival rate for the disease is only 16%, but patients with resected non-small cell lung cancer (NSCLC) have a considerably better prognosis. 2 Staging is a critical aspect of the diagnostic workup of lung cancer as it infl uences treatment decisions and allows accurate communication about prognosis to patients and their families. Lymph node (LN) status is a key component of the lung cancer staging classifi cation system and a strong determinant of prognosis. 3 According to the seventh edition of the TNM classifi cation, 4 nodal status is categorized as N0 (no regional LN involvement), N1 (involvement of

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer

Jonnalagadda

Smith

Mhango

et al. 2011

Chest

View full text Add to dashboard Cite

show abstract

“…In lung cancer, Ludwig and associates [21] recommended that an evaluation of nodal status should include somewhere between 11 to 16 lymph nodes. The study from Varlotto et al [22] evaluated 24,273 patients with stage I NSCLC who underwent a definitive surgical procedure. The optimal number of sampled lymph nodes ensuring the highest staging accuracy should be not less than 11 N1 dissection and 7 N2 dissection lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

“…Two large retrospective reviews conducted by Gajra et al [23] and Doddoli et al [24] analyzing 442 and 465 patients, respectively, found that removal of at least 6 lymph nodes (for patients with six or fewer lymph nodes assessed, DFS was 52%, and the patients with more than six lymph nodes assessed had DFS of 75% at 5 years (p= 0.001)) and dissection of at least 3 mediastinal stations or removal of 10 lymph nodes and dissection of at least 2 mediastinal stations, were associated with improved survival [22] (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Early Stage Non-Small Cell Lung Cancer: The Importance of Number of Resected Lymph Nodes and Vascular Invasion

Santinelli¹

2013

Chemotherapy

View full text Add to dashboard Cite

Background: Despite an appropriate surgical treatment, half of early-stage non-small cell lung cancer patients will die due to lung cancer. The number of resected lymph-nodes and vascular invasion has proved to be a prognostic factor in other solid tumors, as well as breast and colorectal cancer. Here we evaluate their prognostic impact in the largest mono-centric series of resected non-small cell lung cancer patients. Methods:Clinical and pathological characteristics and prognostic outcomes of four hundred thirty-nine consecutive patients undergoing radical surgical resection for non-small cell lung cancer at our Institution were evaluated. Results:The multivariate analysis showed that number of resected lymph nodes, vascular invasion and sex had a prognostic impact on overall survival. The optimal cut-off number of lymph nodes with the highest sensitivity and specificity for estimating the outcome was set at ten after Receiver Operating Characteristics curve analysis. Removing ten lymph nodes in our study represents a cut-off with a significant prognostic impact particularly in resected stage II non-small cell lung cancer. Conclusions:Similarly to other cancer types (for example colorectal cancer), our results suggest that an adequate classification of non-small cell lung cancer should always include an adequate lymph nodes clearance, particularly in stage II non-small cell lung cancer. Again vascular invasion resulted independent prognostic factors for overall survival. Therefore the number of resected lymph nodes, together with vascular invasion, may also drive the selection of nonsmall cell lung cancer patients for adjuvant treatment. Lung cancer is one of more aggressive tumor. Lung tumor surgery with loco-regional lymphadenectomy represents the only way for the eradication of neoplastic disease. In particular, an adequate lymph nodes clearance, especially in stage II non-small cell lung cancer may modify prognosis.

show abstract

Impact of visceral pleural invasion on the association of extent of lymphadenectomy and survival in stage I non‐small cell lung cancer

Zhao

Qiu

et al. 2019

Cancer Medicine

View full text Add to dashboard Cite

Visceral pleural invasion (VPI) has been identified as an adverse prognostic factor for non‐small cell lung cancer (NSCLC). Accurate nodal staging for NSCLC correlates with improved survival, but it is unclear whether tumors with VPI require a more extensive lymph nodes (LNs) dissection to optimize survival. We aimed to evaluate the impact of VPI status on the optimal extent of LNs dissection in stage I NSCLC, using the Surveillance, Epidemiology, and End Results (SEER) database. We identified 9297 surgically treated T1‐2aN0M0 NSCLC patients with at least one examined LNs. Propensity score matching was conducted to balance the baseline clinicopathologic characteristics between the VPI group and non‐VPI group. Log‐rank tests along with Cox proportional hazards regression methods were performed to evaluate the impact of extent of LNs dissection on survival. VPI was correlated with a significant worse survival, but there was no significant difference in survival rate between PL1 and PL2. Patients who underwent sublobectomy had slightly decreased survival than those who underwent lobectomy. Pathologic LNs examination was significantly correlated with survival. Examination of 7‐8 LNs and 14‐16 LNs conferred the lowest hazard ratio for T1‐sized/non‐VPI tumors (stage IA) and T1‐sized/VPI tumors (stage IB), respectively. The optimal extent of LNs dissection varied by VPI status, with T1‐sized/VPI tumors (stage IB) requiring a more extensive LNs dissection than T1‐sized/non‐VPI tumors (stage IA). These results might provide guidelines for surgical procedure in early stage NSCLC.

show abstract

Extent of lymphadenectomy and outcome for patients with stage I nonsmall cell lung cancer

Cited by 120 publications

References 25 publications

The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer

The Number of Lymph Node Metastases as a Prognostic Factor in Patients With N1 Non-small Cell Lung Cancer

Prognostic Factors in Early Stage Non-Small Cell Lung Cancer: The Importance of Number of Resected Lymph Nodes and Vascular Invasion

Impact of visceral pleural invasion on the association of extent of lymphadenectomy and survival in stage I non‐small cell lung cancer

Contact Info

Product

Resources

About