Lymph Node Assessment and Impact on Survival in Video-Assisted Thoracoscopic Lobectomy or Segmentectomy

Zhou, Haiyu; Tapias, Luis F.; Gaissert, Henning A.; Muniappan, Ashok; Wright, Cameron D.; Wain, John C.; Donahue, Dean M.; Morse, Christopher R.; Mathisen, Douglas J.; Lanuti, Michael

doi:10.1016/j.athoracsur.2015.04.034

Cited by 40 publications

(25 citation statements)

References 27 publications

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“…Patients having had less than 11 LNs dissected had significantly less recurrentfree survival, but no effect on overall mortality. Previous studies have shown different results, with number of LNs dissected affecting both overall survival and lung overall survival (2,6,7,12). Possible reasons for the discrepancy could be the small sample size of this present study which carries less statistical power, the shorter follow-up time, or different techniques of data analysis.…”

Section: Discussioncontrasting

confidence: 43%

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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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Section: Discussioncontrasting

confidence: 43%

“…Previous studies have shown that systematic LN dissection (SLND) could improve staging (2)(3)(4)(5) and overall survival compared to LN sampling (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…The reason why more LN scope resulted in a better prognosis might be more accurate staging and less false-negative stage I NSCLC patients (13). Zhou reported that more than 3 LN stations or 10 resected LN were associated with an increase in nodal upstaging and more exact staging (32). Moreover, sampling more than 3 LN stations was found to be an independent predictor for long-term outcomes of lobectomy and segmentectomy in clinical early-stage NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Qu¹,

Wang²,

Zhang³

et al. 2017

J. Thorac. Dis.

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Background: Segmentectomy has the advantage of less complications, but might have less lymph node sampling and higher risk of recurrence. We aimed to compare treatment outcome between two surgical options, and explore the effect of regional lymph node removal on the prognostic difference. Methods:We retrospectively analyzed data of stage I non-small cell lung cancer (NSCLC) (≤3 cm in size) patients who underwent either segmentectomy, or lobectomy, collected from the Surveillance, Epidemiology and End Results (SEER) database, from 2003 to 2013. The primary endpoints were overall survival (OS) and lung cancer-specific survival (LCSS). We also collected data from Shandong Provincial Hospital as validation.Results: Ultimately 1,156 patients treated by segmentectomy and 17,748 patients treated by lobectomy from SEER database were included in the analysis. Overall, segmentectomy was inferior to lobectomy in terms of OS [hazard ratio (HR): 1.316 (1.186-1.461), P<0.001] and LCSS [HR: 1.310 (1.142-1.504), P<0.001]. When the removal of regional lymph nodes (LN) was taken into consideration, no significant difference was found in OS and LCSS, in any Scope of Regional Lymph Node Surgery layer (0, 1-3, more than 3, and biopsy/sentinel layer, all P>0.05). After propensity score matching (PSM), there was no difference between segmentectomy and lobectomy in OS [HR: 1.081 (0.937-1.248), P=0.286] and LCSS [HR: 1.039 (0.861-1.253), P=0.692]. Only sex, age, histology, summary stage, differentiation, tumor size, and radiation still remained as independent prognostic factors for both OS and LCSS. For validation part, there was no significantly prognostic difference between lobectomy and sublobectomy group in overall (P=0.132) and each regional LN removed layer (0, 1-3, more than 3 layers: all P>0.05).Conclusions: Segmentectomy with proper lymph node resection or sampling could be a good alternative to lobectomy. IntroductionLung cancer is the leading cause of cancer-related death (26.5% of all) and has the second highest annual incidence in both males and females (13.3% for each), in the United States (1). More than half of lung cancer patients (57%) have distant metastasis at diagnosis, and overall 5-year relative survival rate is as low as 18% (1). Lung cancer can be divided into small cell lung cancer (SCLC, less than 20%) and non-small cell lung cancer (NSCLC, more than 80%), with entirely different treatment strategies and prognosis (2). Treatment strategies mainly include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy (2). Therein, approximately 69% of NSCLC patients with stages I and II are treated by surgery, compared to only 9% of patients with stages III and IV (2). Surgery is considered the best treatment option for early stage lung cancer, and anatomical lobectomy with N1 and at least three N2 stations sampling or dissection has become the standard surgery for early NSCLC patients (3). Minimally invasive video-assisted thoracoscopic lobectomy is also preferred for stage I NSCLC patients (4...

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“…However, limited resections like wedges and segmentectomies have recently been reconsidered (32)(33)(34), particularly in the elderly and high-risk population. The previously well documented overall survival benefits of lobectomy over limited resections are not observed in patients older than 75 years (25,(35)(36)(37).…”

Section: General Considerationsmentioning

confidence: 99%

Lung cancer in elderly patients

et al. 2016

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Lymph Node Assessment and Impact on Survival in Video-Assisted Thoracoscopic Lobectomy or Segmentectomy

Abstract: Sampling greater than 3 LNS and greater than 10 RNs was associated with an increase in nodal upstaging. Only LNS greater than 3 was found to be an independent predictor of mortality in VATS lobectomy and segmentectomy in clinical early-stage NSCLC.

Cited by 40 publications

References 27 publications

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

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

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Lung cancer in elderly patients

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