A large real-world cohort study of examined lymph node standards for adequate nodal staging in early non-small cell lung cancer

Zhu, Zhihua; Song, Zhengbo; Jiao, Wenjie; Mei, Weijian; Xu, C.; Huang, Qinghua; An, Chaolun; Shi, Jianguang; Wang, Wenxian; Yu, Guiping; Sun, Ping‐Li; Zhang, Yinbin; Shen, Jianfei; Song, Yong; Qian, Jun; Wang, Yao; Yang, Han

doi:10.21037/tlcr-20-1024

Cited by 19 publications

(20 citation statements)

References 23 publications

(32 reference statements)

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“…International standards including those of the National Comprehensive Cancer Network (NCCN) (5), European Society of Thoracic Surgeons (ESTS) (6,7), Chinese Medical Association (CMA) (8), and American College of Surgeons Commission on Cancer (COC) (9) differ regarding the optimal number of examined LNs (ELNs). Samayoa et al's retrospective study revealed that the overall survival (OS) of patients with early NSCLC could be significantly improved with at least 10 ELNs (10), and our previous study arrived at the same conclusion (11). Therefore, a minimum of 10 ELNs served as the basis for the hilar and intrapulmonary LNs quantitative standard (HI standard) in the current study.…”

Section: Introductionsupporting

confidence: 59%

A standard for hilar and intrapulmonary lymph node dissection and pathological examination in early non-small cell lung cancer

Zhu¹,

Mei²,

Song³

et al. 2021

Transl Lung Cancer Res

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Background: There is considerable variation in the staging of lymph nodes (LNs) as part of tumor, node, metastasis (TNM) staging of non-small cell lung cancer (NSCLC). A new dissection and pathological examination standard for hilar and intrapulmonary LNs needs to be established for patients with early-stage T1-3N0M0 NSCLC.Methods: This study involved 3,002 patients with T1-3N0M0 NSCLC who underwent radical lobectomy or total pneumonectomy in the thoracic departments of 11 Chinese institutions between January 1999 and October 2013. The Cox model was applied for univariate and multivariate analyses in the examination of station 10, 11 LN and station 12, 13, 14 LN. A hilar and intrapulmonary standard (HI standard) was then established based on univariate and multiple-factor analyses conducted using the Cox model.Results: Among the 3,002 patients enrolled in the study, 2,609 underwent at least one examination of station 10, 11 LN (A1), while 393 did not undergo examination of station 10, 11 LN (A0). The A0 and A1 groups had 5-year survival rates of 76% and 80%, respectively (P=0.

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Section: Introductionsupporting

confidence: 59%

A standard for hilar and intrapulmonary lymph node dissection and pathological examination in early non-small cell lung cancer

Zhu¹,

Mei²,

Song³

et al. 2021

Transl Lung Cancer Res

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“…A greater NRN was associated with better long-term survival. Focusing on early NSCLC overall, regardless of the pathological node status, a greater NRN can achieve better OS ( 8 , 26 ). However, there were neither benefits nor adverse effects on the OS when more extensive LND was performed in patients with PCs.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 161 patients presented with PLNR ≥13%, and 1461 patients presented with PLNR <13%. The median NRN was 7 (95% CI [4][5][6][7][8][9][10][11][12]. The optimal cut-off value of the NRN for survival was 13 by as determined by X-tile (Figure 2).…”

Section: Patient Characteristicsmentioning

confidence: 98%

“…LND can help detect occult lymph node metastasis and thus evaluate prognosis, as lymph node involvement was suggested to be an independent predictor of worse survival ( 7 ). Although LND is currently accepted as the most accurate and reliable staging procedure for the detection of lymph node involvement, the optimal LND extent, which could be assessed by the number of removed nodes (NRN), remains unclear ( 8 ). Extensive LND might provide more information and potential therapeutic benefits, but the advantages might be offset by an increased risk for postoperative or other complications.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Cut-Off Values of the Positive Lymph Node Ratio and the Number of Removed Nodes for Patients Receiving Resection of Bronchopulmonary Carcinoids: A Propensity Score-Weighted Analysis of the SEER Database

Chen

Wang

et al. 2021

Front. Oncol.

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BackgroundAlthough lymph node dissection (LND) has been commonly used for patients with bronchopulmonary carcinoids (PCs), the prognostic values of the positive lymph node ratio (PLNR) and the number of removed nodes (NRN) remain unclear.MethodsPatients with resected PCs were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015). The optimal cut-off values of the PLNR and NRN were determined by X-tile. The inverse probability of treatment weighting (IPTW) method was used to reduce the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare the overall survival (OS) and cancer-specific survival (CSS) of patients in different PLNR and NRN groups.ResultsThe study included 1622 patients. The optimal cut-off values of the PLNR and NRN for survival were 13% and 13, respectively. In both Kaplan-Meier analysis and univariable Cox proportional hazards regression analysis before IPTW, a PLNR ≥13% was significantly associated with worse OS (HR = 3.364, P<0.001) and worse CSS (HR = 7.874, P<0.001). These findings were corroborated by the IPTW-adjusted Cox analysis OS (HR = 2.358, P = 0.0275) and CSS (HR = 8.190, P<0.001) results. An NRN ≥13 was not significantly associated with worse OS in either the Kaplan-Meier or Cox analysis before or after IPTW adjustment. In the Cox proportional hazards analysis before and after IPTW adjustment, an NRN ≥13 was significantly associated with worse CSS (non-IPTW: HR = 2.216, P=0.013; IPTW-adjusted: HR = 2.162, P=0.024).ConclusionA PLNR ≥13% could predict worse OS and CSS in patients with PCs and might be an important complement to the present PC staging system. Extensive LND with an NRN ≥13 might have no therapeutic value for OS and may even have an adverse influence on CSS. Its application should be considered on an individual basis.

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“…The SEER database is currently the largest database of tumor clinical information in the world. Research on tumors based on SEER has revealed many complex problems in tumor clinical practice [14,15]. However, for recent studies using samples collected over a long period in the SEER database, there are many different editions of AJCC guidelines in terms of tumor stage and other indicators, which makes a comparison of results challenging [16].…”

Section: Discussionmentioning

confidence: 99%

Do Older Patients with Stage IB Non-Small-Cell Lung Cancer Obtain Survival Benefit from Surgery? A Propensity Score Matching Study Based on the SEER Database

Xian

Liu

Wang

et al. 2021

Preprint

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Background: Although surgery is the preferred treatment method for early-stage non-small-cell lung cancer (NSCLC), more than a third of older patients with stage IB NSCLC didn’t receive surgical treatment. Methods: Data of patients with NSCLC was downloaded from the SEER (Surveillance, Epidemiology, and End Results) database, converted from the 7th edition staging to those of the 8th edition staging, and then screened out older patients (aged ≥65 years at diagnosis) with stage IB NSCLC. The propensity score matching (PSM) method was were balanced the distribution proportions of clinical characteristics between the surgery and no surgery groups.Results: After 1:1 propensity score matching, the distribution proportions of clinical characteristics were balanced between the surgery and no surgery groups (P > 0.05, all). The overall survival and disease-specific survival of patients in the surgery group were significantly better than those in the no-surgery group (P < 0.001, both). Furthermore, subgroup analysis showed that receiving surgery was a protective factor for overall survival and disease-specific survival of patients in all clinical character-related subgroups. Ultimately, univariate and multivariate Cox regression analyses showed that gender, tumor size, tumor grade, and tumor classification were independent prognostic factors for overall survival and disease-specific survival in patients undergoing surgery. Conclusions: Older patients with Stage IB NSCLC should opt for surgery without hesitation. This study is expected to provide strong evidence-based medical evidence for the surgical treatment of these patients.

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A large real-world cohort study of examined lymph node standards for adequate nodal staging in early non-small cell lung cancer

Cited by 19 publications

References 23 publications

A standard for hilar and intrapulmonary lymph node dissection and pathological examination in early non-small cell lung cancer

A standard for hilar and intrapulmonary lymph node dissection and pathological examination in early non-small cell lung cancer

Optimal Cut-Off Values of the Positive Lymph Node Ratio and the Number of Removed Nodes for Patients Receiving Resection of Bronchopulmonary Carcinoids: A Propensity Score-Weighted Analysis of the SEER Database

Do Older Patients with Stage IB Non-Small-Cell Lung Cancer Obtain Survival Benefit from Surgery? A Propensity Score Matching Study Based on the SEER Database

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