Extent of Removal for Mediastinal Nodal Stations for Patients with Clinical Stage I Non-Small Cell Lung Cancer: Effect on Outcome

Jeon, Hyun Woo; Moon, Mi Hyung; Kim, Kyung Soo; Kim, Young Du; Park, Hyung Joo; Park, Jae Kil

doi:10.1055/s-0033-1360478

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…It is considered a standard surgical treatment for patients diagnosed preoperatively with lymph node metastases. However, complete lymph node dissection is not regarded as a routine surgical procedure for patients intraoperatively diagnosed as stage I NSCLC, as some studies have demonstrated a lack of significant differences in outcome between selective lymph node sampling and complete lymph node dissection in patients with early-stage lung cancer [13, 17]. …”

Section: Discussionmentioning

confidence: 99%

A prediction model for lymph node metastases using pathologic features in patients intraoperatively diagnosed as stage I non-small cell lung cancer

Zhao

Zhou

et al. 2017

BMC Cancer

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BackgroundThere is little information on which pattern should be chosen to perform lymph node dissection for stage I non-small-cell lung cancer. This study aimed to develop a model for predicting lymph node metastasis using pathologic features of patients intraoperatively diagnosed as stage I non-small-cell lung cancer.MethodsWe collected pathology data from 284 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection from 2013 through 2014, assessing various factors for an association with metastasis to lymph nodes (age, gender, pathology, tumour location, tumour differentiation, tumour size, pleural invasion, bronchus invasion, multicentric invasion and angiolymphatic invasion). After analysing these variables, we developed a multivariable logistic model to estimate risk of metastasis to lymph nodes.ResultsUnivariate logistic regression identified tumour size >2.65 cm (p < 0.001), tumour differentiation (p < 0.001), pleural invasion (p = 0.034) and bronchus invasion (p < 0.001) to be risk factors significantly associated with the presence of metastatic lymph nodes. On multivariable analysis, only tumour size >2.65 cm (p < 0.001), tumour differentiation (p = 0.006) and bronchus invasion (p = 0.017) were independent predictors for lymph node metastasis. We developed a model based on these three pathologic factors that determined that the risk of metastasis ranged from 3% to 44% for patients intraoperatively diagnosed as stage I non-small-cell lung cancer. By applying the model, we found that the values ŷ > 0.80, 0.43 < ŷ ≤ 0.80, ŷ ≤ 0.43 plus tumour size >2 cm and ŷ ≤0.43 plus tumour size ≤2 cm yielded positive lymph node metastasis predictive values of 44%, 18%, 14% and 0%, respectively.ConclusionsA non-invasive prediction model including tumour size, tumour differentiation and bronchus invasion may be useful to give thoracic surgeons recommendations on lymph node dissection for patients intraoperatively diagnosed as Stage I non-small cell lung cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3273-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A prediction model for lymph node metastases using pathologic features in patients intraoperatively diagnosed as stage I non-small cell lung cancer

Zhao

Zhou

et al. 2017

BMC Cancer

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“…However, the number of resected N1, N2, or total LN station was not associated with survival. This is contrary to recent studies that have indicated that the number of LNs has no significant effect on OS and that have recommended that a complete systematic pulmonary and mediastinal lymphadenectomy should be performed in NSCLC 29,30. This may be because in some LN stations, examining minor LNs alone cannot meet the standard of accurate staging.…”

Section: Discussionmentioning

confidence: 59%

The number of resected lymph nodes is associated with the long-term survival outcome in patients with T2 N0 non-small cell lung cancer

Wen¹,

Xi²,

Xi³

et al. 2018

CMAR

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ObjectiveFor the patients with pathologic T2 N0 non-small cell lung cancer (NSCLC), the extent of lymph node (LN) removal required for survival is controversial. We aimed to explore the prognostic significance of examined LNs and to identify how many nodes should be examined.MethodsWe reviewed 549 patients who underwent pulmonary or pneumonectomy surgery or plus lymphadenectomy who were confirmed as T2 stage and LN negative by postoperative pathological diagnosis. According to Martingale residuals of the Cox model, the patients were classified into four groups by the number of examined LNs (1–2 LNs, 3–7 LNs, 8–11 LNs, and ≥12 LNs). Kaplan–Meier analysis and Cox regression analysis were used to evaluate the association between survival and the number of examined LNs.ResultCompared with the 1–2 LNs, 3–7 LNs, and 8–11 LNs groups, the survival was significantly better in the ≥12 LNs group. The 5-year cancer-specific survival rate was 60.5% for patients with 1–2 negative LNs, compared with 68.7%, 72.6%, and 78.4% for those with 3–7, 8–11, and >11 LNs examined, respectively. The 7-year cancer-specific survival rate was 52.9% for patients with 1–2 negative LNs, compared with 63.7%, 63.8%, and 70.8% for those with 3–7, 8–11, and >11 LNs examined, respectively (P=0.045). There was a significant drop in mortality risk with the examination of more LNs. The lowest mortality risk occurred in those with 32 or more LNs examined. Multivariate analysis showed that age and the number of examined LNs were strong independent predictors of survival.ConclusionThe number of examined LNs is a strong independent prognostic factor. Our study demonstrates that patients with T2 N0 NSCLC should have at least 12 LNs examined and that the results of this study may provide information for the optimal number of resected LNs in surgery.

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“…There were three studies by the same research group based on overlapping patients; therefore, only the study with the most complete data was included . Finally, 13 retrospective cohort studies but no RCTs were included, with a total of 4343 patients (730 patients with DM and 3613 patients without) . The main data extracted from these included studies is listed in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Some studies found that DM was significantly correlated with worse OS and RFS in patients with surgically treated NSCLC, [8][9][10] while others found no significant difference. [11][12][13] However, it should be noted that almost all previous studies included a very limited sample of patients with DM, [8][9][10][11][12][13][15][16][17][25][26][27][28] with only one study including a sample of over 100 DM patients. 26 A previous meta-analysis with a sample of 146 DM patients found that patients with DM tended to have a poor prognosis compared to those without, with marginal statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…4,10,24 Finally, 13 retrospective cohort studies but no RCTs were included, with a total of 4343 patients (730 patients with DM and 3613 patients without). [8][9][10][11][12][13][15][16][17][25][26][27][28] The main data extracted from these included studies is listed in Table 1. Almost all of the patients had localized resectable disease and all had undergone relatively long follow-up.…”

Section: Description Of Studiesmentioning

confidence: 99%

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Diabetes mellitus and survival of non‐small cell lung cancer patients after surgery: A comprehensive systematic review and meta‐analysis

et al. 2019

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Background Diabetes mellitus (DM) is one of the most common comorbidities in surgically treated non‐small cell lung cancer (NSCLC) patients and has a negative impact on short‐term outcomes. However, the impact of DM on long‐term survival of such patients remains controversial; therefore, we conducted a comprehensive updated meta‐analysis. Methods We systematically searched relevant studies in PubMed, Embase, Cochrane Library, and Web of Science up to 6 September 2018. Hazard ratios (HRs) for the impact of DM on overall survival (OS) and recurrence‐free survival (RFS) of patients with surgically treated NSCLC were extracted and analyzed using the STATA 12.0 package. Results We included 13 cohort studies consisting of 4343 patients (730 patients with DM and 3613 patients without) with surgically treated NSCLC. Meta‐analysis showed that patients with DM had significantly poorer OS (random effects: HR 1.30, 95% confidence interval 1.05–1.60; P = 0.016) than those without. However, with a limited sample size, there was no significant difference in RFS (random effects: HR 1.06, 95% confidence interval 0.71–1.58; P = 0.786) between patients with and without DM after surgical resection of NSCLC. Conclusion DM is an independent unfavorable prognostic factor for patients with surgically treated NSCLC. High‐quality studies with appropriate adjustment for confounding factors are needed to confirm our conclusions.

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Extent of Removal for Mediastinal Nodal Stations for Patients with Clinical Stage I Non-Small Cell Lung Cancer: Effect on Outcome

Abstract: The extent of dissection of mediastinal lymph nodes affected the clinical outcomes of our study patients with clinical stage I NSCLC. At least evaluation of lobe-specific lymph node dissection is required.

Cited by 10 publications

References 17 publications

A prediction model for lymph node metastases using pathologic features in patients intraoperatively diagnosed as stage I non-small cell lung cancer

A prediction model for lymph node metastases using pathologic features in patients intraoperatively diagnosed as stage I non-small cell lung cancer

The number of resected lymph nodes is associated with the long-term survival outcome in patients with T2 N0 non-small cell lung cancer

Diabetes mellitus and survival of non‐small cell lung cancer patients after surgery: A comprehensive systematic review and meta‐analysis

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