Dual Intervention to Improve Pathologic Staging of Resectable Lung Cancer

Osarogiagbon, Raymond U.; Ramirez, Robert A.; Wang, Christopher G.; Miller, Laura E.; Smeltzer, Matthew P.; Sareen, Srishti; Javed, Ahmed; Robbins, Shaina; Khandekar, Alim; Wolf, Bradley A.; Gibson, Jeffrey B.; Spencer, David P.; Robbins, Edward

doi:10.1016/j.athoracsur.2013.07.009

Cited by 9 publications

(9 citation statements)

References 29 publications

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“…Surgeons may feel that the final lymph node number may be partially out of their control, however interventions such as using a pre-labeled collection kit have increased lymph node yield. [20–21]…”

Section: Commentmentioning

confidence: 99%

Quality Measures in Clinical Stage I Non-Small Cell Lung Cancer: Improved Performance Is Associated With Improved Survival

Samson

Crabtree

Broderick

et al. 2017

The Annals of Thoracic Surgery

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Background National organizations have recommended quality measures for surgery in early-stage non-small cell lung cancer (NSCLC). The outcomes of adherence to these guidelines are unknown. Methods Clinical stage I NSCLC surgery patients were abstracted from the National Cancer Data Base (NCDB). After reviewing current guidelines, the following quality measures were selected: anatomic resection, surgery within 8 weeks of diagnosis, R0 resection, and sampling ≥10 lymph nodes. Multivariate models identified variables independently associated with receiving quality measures and a Cox model created to evaluate overall survival. Results Between 2004 and 2013, 133,026/133,366 (99.7%), 126,598/133,366 (94.9%), 91,472/133,366 (68.6%), and 30,041/133,366 (22.5%) patients met 1, 2, 3, or 4 measures. Income ≥ $38,000/year (OR 1.20, 1.15–1.24), insurance type (private insurance OR 1.22, 1.09 – 1.36, Medicare OR 1.16, 1.04 – 1.30), centers with ≥38 cases/year (OR 1.18, 1.14–1.22), academic institutions (OR 1.31, 1.27–1.35), and clinical Stage IB patients (OR 1.50, 1.40 – 1.60) were more likely to meet all 4 measures; while increasing age (OR 0.99, 0.99–0.99), females (0.93, 0.91 – 0.96), non-Caucasian race (OR 0.83, 0.79 – 0.87) and increasing Charlson/Deyo comorbidity score (1: OR 0.90, 0.87–0.93, ≥2: OR 0.82, 0.79–0.86) were associated with lower likelihood. Pathologic upstaging (HR 1.84, 1.78–1.89) and meeting all 4 measures (HR 0.39, 0.31–0.48) were most powerfully associated with overall survival. Conclusions National adherence to quality measures in stage I NSCLC resection is suboptimal. Guideline compliance is strongly associated with survival and vigorous efforts should be instituted by national societies to improve adherence.

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Section: Commentmentioning

confidence: 99%

Quality Measures in Clinical Stage I Non-Small Cell Lung Cancer: Improved Performance Is Associated With Improved Survival

Samson

Crabtree

Broderick

et al. 2017

The Annals of Thoracic Surgery

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“…Two widely used manuals of gross dissection describe methods to achieve this, but may need to be modified in view of these findings, and reports of improved intrapulmonary lymph node yield from a novel gross dissection protocol [34–36]. The stage-migration possible with the combination of corrective interventions to improve surgical and pathology processes has also been reported, including the impact on post-operative adjuvant therapy eligibility rates [37]. If validated in prospective studies involving more heterogeneous practice settings, wide dissemination and implementation of such improved processes as the standard of care for curative-intent lung cancer resection may provide a practical means of improving lung cancer survival at the broad population level.…”

Section: Commentmentioning

confidence: 99%

Missed Intrapulmonary Lymph Node Metastasis and Survival After Resection of Non-Small Cell Lung Cancer

Smeltzer

Faris

et al. 2016

The Annals of Thoracic Surgery

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Background Pathologic nodal stage is a key prognostic factor for patients with surgically resected lung cancer. We previously described the extent of missed intrapulmonary nodal metastasis in a cohort of patients treated at metropolitan Memphis, TN institutions. With long-term follow-up, we now quantify the survival impact of missed nodal metastasis. Methods We conducted a prospective cohort study to evaluate inadvertently discarded lymph nodes in re-dissected remnant lung resection specimens from lung cancer patients. Retrieved material was histologically examined and classified as lymph nodes with and without metastasis. Survival information was obtained from hospital cancer registries. We plotted survival distributions using the Kaplan Meier method and evaluated them with proportional hazards models controlling for significant demographic and clinical factors. Results The study included 110 patients who were 54% female and 69% Caucasian. Discarded lymph nodes with metastasis were found in 25 (23%) patients. Patients with missed lymph node metastasis had an increased risk of death with an unadjusted hazard ratio of 2.0 (p-value= 0.06) and an adjusted hazard ratio of 1.4 (p-value=0.45) compared with those without missed lymph node metastasis. Patients with >2 missed lymph nodes with metastasis had 4.8 (p-value=0.0005) times the hazard of death compared to patients without missed lymph node metastasis (adjusted hazard ratio =6.5, p-value=0.0001). Conclusions Metastasis to inadvertently discarded intrapulmonary lymph nodes from lung cancer resection specimens was associated with reduced survival. A more rigorous gross dissection protocol for lung cancer resection specimens may provide prognostically useful information.

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“…32 We are actively engaged in a tri-state regional dissemination and implementation study, in which the combination of interventions will be rigorously studied to evaluate the impact on the workload of operating room and pathology laboratory staff, overall stage distribution, and patient survival. These studies will provide a robust cost-effectiveness and overall economic impact analysis of the proposed changes in practice.…”

Section: Discussionmentioning

confidence: 99%

The impact of a novel lung gross dissection protocol on intrapulmonary lymph node retrieval from lung cancer resection specimens

Osarogiagbon¹,

Eke²,

Sareen³

et al. 2014

Annals of Diagnostic Pathology

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Introduction Although thorough pathologic nodal staging provides the greatest prognostic information in patients with potentially curable non-small cell lung cancer, N1 nodal metastasis is frequently missed. We tested the impact of corrective intervention with a novel pathology gross dissection protocol on intrapulmonary lymph node retrieval. Methods Retrospective review of consecutive lobectomy, or greater, lung resection specimens over a period of 15 months before and 15 months after training Pathologist's Assistants on the novel dissection protocol. Results 141 specimens were examined before and 121 specimens after introduction of the novel dissection protocol. The median number of intrapulmonary lymph nodes retrieved increased from 2 to 5 (p<.0001), and the 75th – 100th percentile range of detected intrapulmonary lymph node metastasis increased from 0 – 5 to 0 – 17 (p=.0003). In multivariate analysis, the extent of resection, examination period (pre- or post-intervention), and pathologic N1 (vs. N0) status were most strongly associated with a higher number of intrapulmonary lymph nodes examined. Conclusions A novel pathology dissection protocol is a feasible and effective means of improving the retrieval of intrapulmonary lymph nodes for examination. Further studies to enhance dissemination and implementation of this novel pathology dissection protocol are warranted.

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Dual Intervention to Improve Pathologic Staging of Resectable Lung Cancer

Cited by 9 publications

References 29 publications

Quality Measures in Clinical Stage I Non-Small Cell Lung Cancer: Improved Performance Is Associated With Improved Survival

Quality Measures in Clinical Stage I Non-Small Cell Lung Cancer: Improved Performance Is Associated With Improved Survival

Missed Intrapulmonary Lymph Node Metastasis and Survival After Resection of Non-Small Cell Lung Cancer

The impact of a novel lung gross dissection protocol on intrapulmonary lymph node retrieval from lung cancer resection specimens

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