Impact of L4 lymph node dissection on long-term survival in left-side operable non-small-cell lung cancer: a propensity score matching study

Abstract

OBJECTIVES We investigated the impact of level 4 (L4) lymph node dissection (LND) on overall survival (OS) in left-side resectable non-small-cell lung cancer (NSCLC), with the aim of guiding lymphadenectomy. METHODS A total of 1929 patients with left-side NSCLC who underwent R0 resection between 2001 and 2014 were included in the study. The patients were divided into a group with L4 LND (L4 LND+) and a group without L4 LND (L4 LND−). Propensity score matching was applied to minimize selection bias. The Kaplan–Meier method and Cox proportional hazards model were used to assess the impact of L4 LND on OS. RESULTS A total of 317 pairs were matched. Of the cohort of patients, 20.3% (391/1929) had L4 LND. Of these patients, 11.8% (46/391) presented with L4 lymph node metastasis. L4 lymph node metastasis was not associated with the primary tumour lobes (P = 0.61). Before propensity score matching, the 5-year OS was comparable between the L4 LND+ and L4 LND− groups (69.0% vs 65.2%, P = 0.091). However, after propensity score matching, the 5-year OS of the L4 LND+ group was much improved compared to that of the L4 LND− group (72.9% vs 62.3%, P = 0.002) and L4 LND was an independent factor favouring OS (hazard ratio 0.678, 95% confidence interval 0.513–0.897; P = 0.006). Subgroup analysis suggested that L4 LND was an independent factor favouring OS in left upper lobe tumours. CONCLUSIONS In patients with left-side operable NSCLC, L4 lymph node metastasis was not rare and L4 LND should be routinely performed.

Modification of Pathologic T Classification for Non-small Cell Lung Cancer With Visceral Pleural Invasion

“…The preoperative examination was described in our previous studies. 24,25 Detailed information on the preoperative examination is described in e-Appendix 1.…”

Is major pathologic response sufficient to predict survival in resectable nonsmall‐cell lung cancer patients receiving neoadjuvant chemotherapy?

“…For the latter, the lymph node with escalated SUV (SUV max ≥ 2.5) in PET/CT or with the short axis more than 10 mm in the CT scan was considered malignant 13 . However, PET/CT was not mandatory in our series because it has not yet been covered by medical insurance in mainland China 14,15 …”

“…13 However, PET/CT was not mandatory in our series because it has not yet been covered by medical insurance in mainland China. 14,15…”

A Rare Subtype of Non-small Cell Lung Cancer: Report of 159 Resected Stage I-IIIA Pulmonary Lymphoepithelioma-like Carcinoma Cases

“…In general, postoperative follow-up was carried out every 3 months for the rst 2 years, every 6 months for the next 3-5 years, and annually thereafter (15)(16)(17)(18). At each follow-up visit, a physical examination and chest and abdominal CT scans were performed (15).…”

“…At each follow-up visit, a physical examination and chest and abdominal CT scans were performed (15). If the patient had speci c symptoms, the examination was performed as soon as possible for a more careful assessment (15)(16)(17)(18). Follow-up information was updated in October 2020 to determine patients' vital status.…”