Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer?

Doddoli, Christophe; Aragon, Adrian; Barlési, Fabrice; Chetaille, Bruno; Robitail, S.; Giudicelli, R; Fuentès, P.; Thomas, Philippe

doi:10.1016/j.ejcts.2004.12.035

Cited by 132 publications

(96 citation statements)

References 22 publications

(38 reference statements)

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“…It is noteworthy that, even for patients who underwent complete mediastinal lymphadenectomy, the median survival of those who had an RUL tumor location (not reached) was better numerically than for those who had an RLL tumor location (50.7 months). 23 Thus, better staging of the mediastinal lymph nodes, especially Level 8 and 9 lymph nodes, by endoscopic, ultrasound-guided fine-needle aspiration; integrated computed tomography-positron emission tomography fusion scan; video-assisted thoracoscopy 24 ; or more complete mediastinal lymphadenectomy [25][26][27][28] will provide better management for nonupper lobe tumors in patients with early-stage NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival of stage I nonsmall cell lung cancer patients

Zell

Ziogas

et al. 2007

Cancer

191

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BACKGROUND. Platinum‐based adjuvant chemotherapy in randomized trials has failed to provide a survival benefit in patients with resected stage I nonsmall cell lung cancer (NSCLC). Using data from the California Cancer Registry (CCR), we explored factors that had detrimental effects on survival in patients with stage I NSCLC to identify a subset of patients at high risk for disease recurrence and subsequent mortality. METHODS. Between 1989 and 2003, 19,702 incident cases of stage I NSCLC in the CCR were identified and subgrouped into stage IA and IB disease. Patient demographic factors, tumor characteristics, and treatment delivered were examined. Kaplan‐Meier survival curves were calculated to estimate survival rates. Cox proportional‐hazards ratios were used to identify independent prognostic factors for survival. RESULTS. Advanced age at diagnosis, male sex, low socioeconomic status (SES), nonsurgical treatment, and poor histologic grade (stage IA NSCLC: hazards ratio [HR], 1.13; 95% confidence interval [95% CI], 1.08–1.19; stage IB NSCLC: HR, 1.11; 95% CI, 1.07–1.16) were associated with increased mortality risk on multivariate analysis. Nonupper lobe tumor location (right middle lobe, right and left lower lobes) and tumor size ≥4 cm (vs <4 cm: HR, 1.23; 95% CI, 1.15–1.30) were additional factors that increased the risk of mortality among patients with stage IB disease. Bronchioloalveolar carcinoma and Asian ethnicity were associated with decreased mortality risk in stage I NSCLC. CONCLUSIONS. Stage I NSCLC with poorly differentiated histology and stage IB NSCLC with nonupper lobar tumor location or tumor size ≥4 cm carried an increased mortality risk. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival of stage I nonsmall cell lung cancer patients

Zell

Ziogas

et al. 2007

Cancer

191

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“…Meanwhile, Izbicki (10) and Graham (38) argued that LND should be routinely operated for resectable NSCLC. On one hand, whether LND would increase postoperative morbidity associated with complications is not clear (10,36) and the influence on outcome such as overall survival and diseasefree survival remains controversial (5,8,17,33,34). On the other hand, the reported benefit that SLND can shorten the entire medical period along with its validity, reliability and applicability are still not very clear.…”

Section: Discussionmentioning

confidence: 92%

“…Among all the lung cancer-therapeutic methods, surgery plays a pivotal role, especially in the early-stage nonsmall cell lung cancer (NSCLC). Nowadays, the standard surgical treatment of early-stage NSCLC is lobectomy with systematic lymph node dissection (LND) as recommended by the guidelines (3,4), which capable of providing accurate staging (5,6), detecting occult metastasis (7) and improving survival (5,8,9). However, randomized trials have not demonstrated that LND has more survival benefit than sampling (7,10).…”

Section: Introductionmentioning

confidence: 99%

Selective lymph node dissection in early-stage non-small cell lung cancer

Han

Chen

2017

J. Thorac. Dis.

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Lymph node dissection is a vital part of surgical treatment in early-stage non-small cell lung cancer (NSCLC). Removal of metastatic lymph nodes while preservation of intact lymph nodes are equally important. For hospitalized early-stage patients with limited lymph node metastasis, the operation treatment should be made according to some rules such as lobe-specific lymph node drainage pattern. In order to prevent unnecessary surgical trauma in early-stage patients, a minimally invasive approach with selective lymph node excision is preferred for more clinical benefits. This review summarizes the existing findings on lobe-specific lymph node drainage pattern and we hope to provide guidance for selective lymph node dissection (SLND). Furthermore, we include information on histologic views, a tumor marker and protocols of SLND, with hope to inspire creative research and clinical trials in this field.

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“…The proponents of MLNR assert that it improves the staging accuracy by increasing LN harvest and enhances the identification of occult N2 disease (3,4). With respect to therapeutic effect, MLNR-according to its proponentsdecrease recurrence and increase survival by removing the occult N2 disease.…”

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confidence: 99%