Postoperative Survival and the Number of Lymph Nodes Sampled During Resection of Node-Negative Non-Small Cell Lung Cancer

Ludwig, Michelle; Goodman, Michael; Miller, Daniel; Johnstone, Peter A.S.

doi:10.1378/chest.128.3.1545

Cited by 235 publications

(187 citation statements)

References 21 publications

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“…Patients having had less than 11 LNs dissected had significantly less recurrentfree survival, but no effect on overall mortality. Previous studies have shown different results, with number of LNs dissected affecting both overall survival and lung overall survival (2,6,7,12). Possible reasons for the discrepancy could be the small sample size of this present study which carries less statistical power, the shorter follow-up time, or different techniques of data analysis.…”

Section: Discussionmentioning

confidence: 60%

“…However, the effect of the number of dissected LNs on tumor recurrence or overall survival is still controversial. Some studies reported that the number of LNs removed in early stage NSCLC patients who underwent lobectomy was an independent positive prognostic factor for overall and lung overall survival (6,12,13). Other studies suggest that the number of dissected LNs has no significant impact on overall survival, whereas the number of positive LNs does (14,15).…”

Section: Introductionmentioning

confidence: 99%

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Impact of lymph node management on resectable non-small cell lung cancer patients

et al. 2017

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Results: The average number of dissected LNs was 22.7±12.8. Tumor recurrence was found in 51.3% and overall mortality was 43.3%. The number of dissected LNs was a prognostic factor for tumor recurrence [HR 0.98, 95% confidence interval (CI): 0.96-0.99]. There was a significant difference at the cut-pointed value of 11 dissected LNs for tumor recurrence (HR 2.22, 95% CI: 1.26-3.92). Dissection less than 11 nodes and less than 5 stations indicated a poor prognostic factor for tumor recurrence: for 3-4 stations (HR 3.01, 95% CI: 1.22-7.42) and for 1-2 stations (HR 1.96, 95% CI: 1.04-3.72). The positivity of dissected LNs was also a prognostic factor for tumor recurrence and overall mortality (HR 1.01, 95% CI: 1.01-1.02 and HR 1.01, 95% CI: 1.01-1.03, respectively).Conclusions: Eleven or more LN dissection with at least 5 stations influenced recurrent-free survival.Systematic LN dissection (SLND) should be performed not only to identify the positivity of dissected LNs but also to determine an accurate tumor nodal stage. A larger cohort should be further conducted to support these findings.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Impact of lymph node management on resectable non-small cell lung cancer patients

et al. 2017

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“…The association between postoperative survival and the number of lymph nodes has been recently examined by Ludwig et al [21] mentioned above, in a large series of 16,800 patients who underwent definitive resection of node-negative (stage IA or stage IB) NSCLC. A modest but statistically significant increase in survival was evident in patients with five to eight lymph nodes examined during surgery in comparison to patients with one to four lymph nodes, with a proportionate hazard ratio (HR) of 0.90 and a 95% confidence interval (CI) of 0.84 to 0.97.…”

Section: Discussionmentioning

confidence: 99%

“…In gastric cancer, we previously showed that an inadequate lymph nodes resection can affect survival and result in a higher incidence of local relapse [20]. 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.…”

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

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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.

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“…In that report, 5-year survival for patients who had received curative-intent resection for pN0 NSCLC ranged from 54% in Europe to 79% in Asia (represented by Japan and South Korea), and the pN1 survival ranged from 34% to 54% (10). Thoroughness of examination, using the number of lymph nodes examined as a surrogate, has been strongly linked with survival (15)(16)(17). Specifically, the thoroughness of mediastinal nodal sampling (to search for N2 or N3 metastasis) and the thoroughness of retrieval of intrapulmonary lymph nodes (to search for N1 metastasis) have been directly linked with survival (13,(17)(18)(19).…”

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confidence: 99%

Improving post-resection risk stratification in non-small cell lung cancer: ‘wit, whither wander you?’

Osarogiagbon¹

2016

J. Thorac. Dis.

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Postoperative Survival and the Number of Lymph Nodes Sampled During Resection of Node-Negative Non-Small Cell Lung Cancer

Cited by 235 publications

References 21 publications

Impact of lymph node management on resectable non-small cell lung cancer patients

Impact of lymph node management on resectable non-small cell lung cancer patients

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

Improving post-resection risk stratification in non-small cell lung cancer: ‘wit, whither wander you?’

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