Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non–Small-Cell Lung Cancer: A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry

Liang, Wenhua; He, Jiaxi; Shen, Yaxing; Shen, Jianfei; He, Qihua; Zhang, Jianrong; Jiang, Gening; Wang, Qun; Liu, Lunxu; Gao, Shugeng; Liu, Deruo; Wang, Zheng; Zhu, Zhihua; Ng, Calvin S.H.; Liu, Chia Chuan; Petersen, René Horsleben; Rocco, Gaetano; D’Amico, Thomas A.; Brunelli, Alessandro; Chen, Haiquan; Zhi, Xiao; Liu, Bo; Yang, Yixin; Chen, Wensen; Zhou, Qian

doi:10.1200/jco.2016.67.5140

Cited by 275 publications

(272 citation statements)

References 26 publications

(17 reference statements)

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“…However, the accuracy of pN stage is also impacted by various factors. Adequate numbers of stations and LNs need to be collected during surgery, correctly labeled, and sent for pathological examination . In the pathological laboratory, the LNs of various stations should be routinely examined, including intrapulmonary LNs.…”

Section: Discussionmentioning

confidence: 99%

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

et al. 2018

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BackgroundIntrapulmonary lymph nodes (LNs, stations 11–14) are usually omitted in postoperative pathological examination. Some non‐small cell lung cancer (NSCLC) patients with intrapulmonary LN metastasis are incorrectly diagnosed as N0 cases. Furthermore, underestimation of intrapulmonary LN involvement in clinically early stage NSCLC may lead to the incorrect choice of surgical procedure: lobectomy or sublobar resection. This study was conducted to determine the status of intrapulmonary LN involvement in clinically staged IA (c‐T1N0M0) peripheral adenocarcinoma of the lung.MethodsSeventy‐five lobectomy specimens of c‐T1N0M0 peripheral adenocarcinoma of the lung were carefully dissected to find intrapulmonary LNs. The longest diameter of each intrapulmonary LN was measured and sent for pathological examination, together with hilar and mediastinal LNs, to investigate the relationship between LN metastasis and primary tumor size.ResultsIntrapulmonary LN metastasis was detected in 22.7%(17/75) of patients. Positive LNs were detected in 21.7% (10/46) of T1b patients and 45% (11/24) of T1c patients, while no metastasis (0/5) was observed in T1a patients (P = 0.036). The mean longest diameter of the 17 involved intrapulmonary LNs was only 6.5 ± 2.1 mm, which was not significantly different to the size of negative intrapulmonary LNs (5.2 ± 1.4 mm).ConclusionsIntrapulmonary LN metastasis is common in clinically staged IA peripheral adenocarcinoma of the lung. LN metastasis is related to tumor size, and this should be taken into account to determine appropriate surgical procedures and postoperative treatment. Computed tomography is not a reliable method to judge LN metastasis, particularly intrapulmonary LN metastasis.

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Section: Discussionmentioning

confidence: 99%

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

et al. 2018

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“…Recently, Liang et al reported data from a Chinese multiinstitutional registry and the US SEER database on stage I to IIIA resected NSCLC [2001][2002][2003][2004][2005][2006][2007][2008]; in this paper, a larger number of examined LNs was associated with more-accurate node staging and better long-term survival. The authors recommended 16 LNs as the cut point for evaluating the quality of LN examination and declaring a node-negative disease (22). However, the data of the stations of dissected LNs was not available in that publication.…”

Section: Discussionmentioning

confidence: 99%

Impact of lymph node management on resectable non-small cell lung cancer patients

et al. 2017

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Results: The average number of dissected LNs was 22.7±12.8. Tumor recurrence was found in 51.3% and overall mortality was 43.3%. The number of dissected LNs was a prognostic factor for tumor recurrence [HR 0.98, 95% confidence interval (CI): 0.96-0.99]. There was a significant difference at the cut-pointed value of 11 dissected LNs for tumor recurrence (HR 2.22, 95% CI: 1.26-3.92). Dissection less than 11 nodes and less than 5 stations indicated a poor prognostic factor for tumor recurrence: for 3-4 stations (HR 3.01, 95% CI: 1.22-7.42) and for 1-2 stations (HR 1.96, 95% CI: 1.04-3.72). The positivity of dissected LNs was also a prognostic factor for tumor recurrence and overall mortality (HR 1.01, 95% CI: 1.01-1.02 and HR 1.01, 95% CI: 1.01-1.03, respectively).Conclusions: Eleven or more LN dissection with at least 5 stations influenced recurrent-free survival.Systematic LN dissection (SLND) should be performed not only to identify the positivity of dissected LNs but also to determine an accurate tumor nodal stage. A larger cohort should be further conducted to support these findings.

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“…For patients undergoing lobectomy for NSCLC, accumulating data have demonstrated that a greater number of harvested LNs is associated with improved survival (10,11). Normally, only patients with node-negative disease in preoperative clinical staging are deemed to be suitable candidates for segmentectomy.…”

Section: Introductionmentioning

confidence: 99%

Appropriate lymphadenectomy significantly reduced recurrence after segmentectomy for patients with non-small cell lung cancer

Wang¹,

Gu²,

Pan³

et al. 2018

J. Thorac. Dis.

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Background: Segmentectomy has been widely used for small-sized non-small cell lung cancer (NSCLC).The objective of this study is to determine the impact of number of harvested lymph nodes (LNs) on survival for patients undergoing segmentectomy. Methods: The clinicopathologic data of patients undergoing segmentectomy for NSCLC from July 2011 to December 2014 were retrospectively analyzed. Survival analysis was performed by Kaplan-Meier method and Cox regression analysis. Results: A total of 259 patients with NSCLC were eligible for analysis. Patients with harvested LN ≥6 had higher frequency of nodal metastasis in pathologic examination (9.4% vs. 1.5%, P=0.005). The 3-year recurrence-free survival (RFS) of patients with harvested LN ≥6 (90.2%) was significantly higher than that of patients with harvested LN <6 (73.7%, log-rank P=0.038). Multivariable Cox analysis identified harvested LN ≥6 as an independent predictor for improved RFS [hazard ratio (HR) =0.35; 95% confidence interval (CI): 0.14-0.90; P=0.029]. There was no significant difference in RFS between patients with harvested LN station ≥3 and <3 (log-rank P=0.34). Conclusions: The number of harvest LN ≥6 was independently associated with improved RFS for NSCLC patients undergoing segmentectomy, supporting the National Comprehensive Cancer Network (NCCN) guidelines of appropriate LN sampling.

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Impact of Examined Lymph Node Count on Precise Staging and Long-Term Survival of Resected Non–Small-Cell Lung Cancer: A Population Study of the US SEER Database and a Chinese Multi-Institutional Registry

Cited by 275 publications

References 26 publications

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

Impact of lymph node management on resectable non-small cell lung cancer patients

Appropriate lymphadenectomy significantly reduced recurrence after segmentectomy for patients with non-small cell lung cancer

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