Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer

Rucker, A. Justin; Raman, Vignesh; Jawitz, Oliver K.; Voigt, Soraya L.; Tong, Betty C.; D’Amico, Thomas A.; Harpole, David H.

doi:10.1016/j.athoracsur.2020.04.117

Cited by 15 publications

(11 citation statements)

References 10 publications

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“…According to previous studies, the positive prognostic effects of more extensive dissection have been demonstrated in early-stage colon cancer (18), breast cancer (19), and gastric cancer (20). Additionally, Rucker et al consistently demonstrated that the assessment of more lymph nodes was associated with better survival in pT1-2N0M0 small cell lung cancer (21). In our study, the lowest HR of OS and CSS existed in both ≥9 LNE and ≥4 LNR via univariate Cox proportional hazards regression analysis.…”

Section: Discussionsupporting

confidence: 67%

The Independent Prognostic Effect of Lymph Node Dissection on Patients With Stage IA NSCLC With Different T Stages

et al. 2021

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Background: Currently, the extent of lymph node evaluation necessary for patients with early-stage non-small-cell lung cancer (NSCLC) remains controversial according to the latest ESMO and NCCN guidelines. In this study, we aimed to evaluate the survival effect of different numbers of lymph nodes examined (LNE) and regions of lymph nodes removed (LNR) in patients with stage IA NSCLC.Method: All patients with stage IA NSCLC undergoing lobectomy or bilobectomy were selected from the surveillance, epidemiology, and end results (SEER) database. The number of LNE and LNR were stratified into 4 groups (0, 1–2, 3–8, and ≥9 lymph nodes) and 3 groups (0, 1–3, and ≥4 regions) respectively. Additionally, the survival curves of overall survival (OS) and cancer-specific survival (CSS) were plotted and compared with the Kaplan-Meier method and log-rank test. Independent prognostic clinicopathological factors were evaluated via Cox proportional hazard regression and subgroup analysis.Results: Totally, 12,490 patients with stage IA NSCLC were enrolled in our study. Patients with ≥9 LNE and ≥4 LNR in both the T1b and T1c stages consistently demonstrated the significantly best OS and CSS outcomes. In the multivariate analysis, patients with ≥9 LNE consistently had a significantly better CSS [hazards ration (HR) (95% CI):0.539 (0.438–0.663)], and those with ≥4 LNR consistently had a significantly better OS [HR (95% CI):0.678 (0.476–0.966)]. Furthermore, ≥9 LNE and ≥4 LNR were associated with better survival in most subgroups.Conclusion: This study demonstrated that ≥9 LNE and ≥4 LNR are highly recommended for stage IA2 and stage IA3 patients but optional for stage IA1 patients.

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Section: Discussionsupporting

confidence: 67%

The Independent Prognostic Effect of Lymph Node Dissection on Patients With Stage IA NSCLC With Different T Stages

et al. 2021

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“…This difference may have arisen because the patients in our study all received postoperative chemotherapy, but those in Raman's did not. In relation to lymph node dissection, a previous study found that there was no difference in survival outcomes when the number of dissected lymph nodes for LS-SCLC increased (22). Our research also indicated that the number of lymph nodes dissected or sampled during the LS-SCLC operation did not affect cancer recurrence or survival outcomes.…”

Section: Discussionsupporting

confidence: 52%

Comprehensive analysis of prognostic predictors for patients with limited-stage small-cell lung cancer who underwent resection followed by adjuvant chemotherapy

et al. 2021

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Background: The prognosis of patients with limited-stage small-cell lung cancer (LS-SCLC) who undergo resection followed by adjuvant chemotherapy (ACT) is uncertain. Thus, we combined clinicopathological characteristics and next-generation sequencing (NGS) to answer this question.Methods: In total, the data of 51 LS-SCLC patients who had undergone complete surgical resection and postoperative ACT were retrospectively collected. NGS examinations with a 68-gene panel were performed for each specimen. Patients' genetic status and potentially clinical correlations were statistically evaluated.Progression-free survival (PFS) and overall survival (OS) were plotted using Kaplan-Meier curves. The independent prognostic factors for the primary cohort were investigated using univariable and multivariable cox proportional hazard regression analyses. Subgroup analyses were also conducted based on retinoblastoma protein 1 (RB1) status.Results: Combined SCLC (c-SCLC) had similar clinical and pathological characteristics to that of pure SCLC (p-SCLC). TP53 and RB1 were 2 major genetic mutations present in both p-SCLC and c-SCLC. c-SCLC had a unique genetic profile that was related to the PI3K/AKT/mTOR and WNT/β-catenin signaling pathways. There was no prognostic difference between c-SCLC and p-SCLC. However, the pathological node (N) stage of lymphovascular invasion (LVI), which was related to PFS and age, corelated with OS. Neither pathological subtypes nor genetic mutations affected the survival outcomes. Notably, RB1 mutated c-SCLC resulted in poorer DFS compared to that of p-SCLC among LS-SCLC patients who underwent resection followed by ACT.Conclusions: Our examination of LS-SCLC patients who underwent resection followed by ACT showed that c-SCLC and p-SCLC had a clinical and prognostic similarity and a genetic peculiarity. Thus, it is essential that a new classification system be proposed for SCLC. Such a system is especially needed for LS-SCLC.

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“…A large population-based study [ 29 ] proposed that the detection of ≥16 lymph nodes can improve the accuracy of node staging and the long-term survival of resected NSCLC. A study based on the National Cancer Database [ 30 ] found that patients may benefit from retrieval of ≥7 lymph nodes during lobectomy for limited-stage small-cell lung cancer, but the optimal number of lymph nodes that should be removed for TC tumours remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Sublobar resection versus lobectomy for patients with stage T1-2N0M0 pulmonary typical carcinoid tumours: a population-based propensity score matching analysis

Yang

Mei

2022

Interactive CardioVascular and Thoracic Surgery

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Objectives It is widely accepted that surgical resection of localized pulmonary typical carcinoid (TC) tumours remains the primary curative modality. However, the optimal extent of resection remains controversial. This study aimed to investigate the survival rates of patients with stage T1-2N0M0 TC tumours who underwent sublobar resection or lobectomy. Methods We queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery after being diagnosed with stage T1-2N0M0 TCs from 2004 to 2016. Propensity score matching (PSM) analysis was used to equalize baseline characteristics between the sublobar resection group and the lobectomy group. Kaplan–Meier analysis and the Cox proportional hazard model were performed for survival analysis. Results Of the 2469 patients included, 658 (26.65%) underwent sublobar resection and 1811 (73.35%) underwent lobectomy. All 2469 patients were analysed with PSM and, following PSM, 812 patients were included in the final analysis, divided into two groups of 406 patients. In the matched cohort, Kaplan–Meier analysis demonstrated no significant difference in survival curves between the sublobar resection and lobectomy groups in patients with stage T1-2N0M0 TC tumours (5-year OS = 90.78% versus 93.30%; HR 1.18, 95% CI: 0.77–1.80; P = 0.505). Subgroup analysis by tumour size showed that the sublobar resection group was identical to the lobectomy group in overall survival (OS) for tumours ≤3.0 cm. In addition, no difference in OS between surgical groups was observed in any subgroups. In multivariable Cox analysis, age ≤ 65y, female sex, married status, and adequate lymph node assessment (≥5) were associated with improved OS, whereas the extent of resection was not. Conclusions Sublobar resection seems to be associated with similar survival to lobectomy for stage T1-2N0M0 TC tumours if lymph node assessment is performed adequately. This analysis suggests sublobar resection should be considered an appropriate alternative for stage T1-2N0M0 TC tumours. However, further validations are needed in large, multicentre prospective studies.

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Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer

Cited by 15 publications

References 10 publications

The Independent Prognostic Effect of Lymph Node Dissection on Patients With Stage IA NSCLC With Different T Stages

The Independent Prognostic Effect of Lymph Node Dissection on Patients With Stage IA NSCLC With Different T Stages

Comprehensive analysis of prognostic predictors for patients with limited-stage small-cell lung cancer who underwent resection followed by adjuvant chemotherapy

Sublobar resection versus lobectomy for patients with stage T1-2N0M0 pulmonary typical carcinoid tumours: a population-based propensity score matching analysis

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