Exploration of the optimal number of regional lymph nodes removed for resected N0 NSCLC patients: A population-based study

Abstract

BackgroundThe aim of our study was to explore the optimal number of regional lymph nodes removed (LNRs) in resected N0 non-small cell lung cancer (NSCLC) patients and identify potential risk factors.MethodsIncluded in this study were 55,024 N0 NSCLC patients between 2004 and 2015 based on the Surveillance, Epidemiology, and End Results database (SEER). All the patients were divided into No LNR group (57.8%), 1-3 LNRs group (8.1%) and ≥4 LNRs group (31.4%). Relevant clinical and patient parameters including overall survival (OS), lung cancer-specific survival (LCSS), gender, race, year of diagnosis, primary site, T stage, AJCC stage, laterality, histological type, lymphadenectomy, radiation, chemotherapy, age at diagnosis, insurance status, marital status, family income.ResultsKaplan-Meier analysis demonstrated LNRs had significantly better OS and LCSS than No LNRs in all the N0 NSCLC patients with different T stages (Logrank p<.001). Univariate and multivariate analysis showed that both OS and LCSS in ≥ 4 LNRs group were better than those in <1-3 LNRs group (OS: ≥4 LNRs group: HR, 0.583; 95%CI, 0.556-0.610; P<.001 vs.1-3 LNRs group: HR, 0.726; 95%CI, 0.687-0.769; P<.001; LCSS: ≥4 LNRs group: HR, 0.514; 95%CI, 0.480-0.550; P<.001 vs.1-3 LNRs group: HR, 0.647; 95%CI, 0.597-0.702; P<.001). In addition, whites, males, not upper lobe, large cell carcinoma and others, advance T stage or AJCC stage, no surgery, no LNR, no radiation, no chemotherapy, elder age at diagnosis, singled marital status and low family income had negative impact on prognosis of N0 NSCLC patients.ConclusionsOur study suggests that ≥ 4 LNRs can yield better survival outcomes compared with 1-3 LNRs in N0 NSCLC patients.

Analysis of predictive factors of unforeseen nodal metastases in resected clinical stage I NSCLC

“…This underscores the importance of performing an adequate lymphadenectomy in improving the oncological outcomes of early-stage NSCLC patients (12). These findings align with other studies that have examined the number of harvested nodes at surgery and its association with survival (13). Patients who had a greater number of resected lymph nodes appeared to have better outcomes, and systematic lymphadenectomy with more than 10 harvested lymph nodes resulted in improved survival outcomes, particularly in a specific subgroup of patients with tumor diameter less than 20mm (14).…”

Impact of examined lymph node count on survival outcomes in patients with stage T1-2N0M0 small cell lung cancer undergoing surgery: A retrospective cohort study

“…[18] Studies have demonstrated that a higher number of examined lymph nodes in NSCLC is associated with improved survival outcomes, likely due to more precise staging and the resultant tailored treatment strategies. [19][20][21][22][23][24][25][26] However, the application of these findings to SCLC is not straightforward due to the more aggressive nature and different treatment paradigms of SCLC.…”