Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

Adachi, Hiroyuki; Nakayama, Haruhiko; Masuda, Munetaka

doi:10.21037/jtd.2017.07.77

Cited by 9 publications

(10 citation statements)

References 20 publications

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“…Further prospective studies, including covariates related to the time of recurrence, are required to confirm our results. Third, we excluded patients who underwent sublobar resection because lobectomy with lymph node dissection is considered the standard treatment for early stage disease ( 35 ). Finally, patients with second primary lung cancer were excluded.…”

Section: Discussionmentioning

confidence: 99%

Prognosis and recurrence patterns in patients with early stage lung cancer: a multi-state model approach

Jeong¹,

Choi²,

Chae³

et al. 2022

Transl Lung Cancer Res

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Background: We aimed to assess whether recurrence patterns affect survival and to use a multi-state model to predict the prognosis of early stage non-small cell lung cancer in patients who underwent surgical resection.Methods: Patients with early stage non-small cell lung cancer who underwent surgical resection at two tertiary medical centers between 2010 and 2015 were retrospectively analyzed. A multi-state model was employed with one initial state (surgery), two intermediate states (locoregional recurrence, distant metastasis), and one absorbing state (death), comprising five transitions: surgery to locoregional recurrence, surgery to distant metastasis, surgery to death without recurrence, locoregional recurrence to death, and distant metastasis to death. Cox proportional hazards models stratified for these transitions were performed with the risk factors; transition probabilities for each patient were predicted.Results: A total of 949 patients were identified [median age: 67 years, male: 614 (64.6%)]. Recurrence occurred in 194 (20.4%) patients (locoregional recurrence: 7.3%, distant metastasis: 13.1%). Hazard ratios for distant metastasis after surgery were higher for older age (hazard ratio: 1.03, 95% confidence interval:1.01-1.06) and adenocarcinoma (hazard ratio: 1.67, 95% confidence interval: 1.06-2.61). Lower lobe location exhibited a higher hazard ratio for death after surgery without recurrence (hazard ratio: 1.59, 95% confidence interval: 1.00-2.53). Stage IIB lung cancer showed a higher probability of transition to distant metastasis after surgery than other stages. Cumulative transition hazards rapidly increased in both recurrence patterns until approximately two years after surgery (locoregional recurrence: 0.052; distant metastasis: 0.104).Patients with distant metastasis were more likely to die within 5 years of surgery than those with locoregional recurrence (6.8% and 2.6%, respectively).Conclusions: With the multi-state model, risk factors and post-relapse survival probabilities differed between locoregional recurrence and distant metastasis. These findings may enable clinicians to establish personalized follow-up strategies for patients undergoing curative resection for early stage non-small cell lung cancer.

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Section: Discussionmentioning

confidence: 99%

Prognosis and recurrence patterns in patients with early stage lung cancer: a multi-state model approach

Jeong¹,

Choi²,

Chae³

et al. 2022

Transl Lung Cancer Res

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“…Especially for early-stage non-small cell lung cancer, several studies have concluded that SLND is not necessary. Many recent studies have suggested that LSLND and LNS can achieve the same therapeutic effect as SLND for early-stage NSCLC 5 , 6 , 9 , 12 , 16 , 17 . At the same time, some studies suggest that LSND and LNS can reduce the incidence of complications caused by lymph node dissection, such as lymphatic fistula, bleeding, and nerve damage 18 .…”

Section: Discussionmentioning

confidence: 99%

“…However, for early-stage NSCLC, the method of lymph node Ivyspring International Publisher dissection has been controversial. Many studies suggest that lobe-specific selective lymph node dissection (LSLND) and lymph node sampling (LNS) can be applied to early-stage NSCLC [5][6][7][8][9][10][11]. These studies indicate that for early-stage NSCLC, LSLND and LNS can reduce operative time and some perioperative complications and have no difference in survival compared with SLND [6][7][8][9]12].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the necessity of Pulmonary Ligament Lymph Node Dissection for Upper Lobe Stage IB NSCLC: A Propensity Score-matched Study

Wang¹,

Yu²,

Han³

et al. 2022

J. Cancer

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Objective: The purpose of this study was to explore whether the resection of pulmonary ligament lymph nodes would affect the prognosis of patients with stage IB non-small cell lung cancer (NSCLC). Methods: We retrospectively analyzed 341 patients with upper lobe stage IB NSCLC who underwent radical surgery for lung cancer at Sun Yat-Sen University Cancer Center from 1999 to 2009. The Cox proportional hazard regression model was used to analyze the prognostic factors. After propensity score matching (PSM), 204 cases were selected. The Kaplan-Meier method and log-rank test were applied to compare overall survival (OS) and recurrence-free survival (RFS). Results: Among the 341 cases included in the study, 217 had no pulmonary ligament lymph nodes resected, and 124 had pulmonary ligament lymph nodes resected. They were divided into two groups according to whether the pulmonary ligament lymph nodes were resected; there were significant differences between the two groups in laterality, resected lymph node stations, and resected lymph node numbers ( P <0.05). Univariate and multivariate analyses by the Cox proportional hazards model showed that age and family history of malignant tumors were prognostic factors for OS, and no variables were prognostic factors for RFS ( P <0.05). Resection of the pulmonary ligament lymph node was not associated with OS or RFS. After propensity score matching (PSM), survival analysis was performed again using the Kaplan-Meier method and log-rank test; the results suggested that resection of the pulmonary ligament lymph node is not statistically associated with OS and RFS ( P >0.05). Conclusions: For stage IB NSCLC, resection of the pulmonary ligament lymph nodes was not statistically associated with OS or RFS. Pulmonary ligament lymph node resection is not necessary for early-stage NSCLC.

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“…A prospective clinical trial including 1,023 early-stage NSCLC patients showed no difference in RFS and OS between SLND and LNS (13,21). For early-stage NSCLC, several studies found no difference in survival and recurrence rate between LSLND and SLND (16,22,23).…”

Section: Discussionmentioning

confidence: 99%

Significance of upper paratracheal lymph node resection in stage IB right lung cancer

Wang

Han

et al. 2022

Preprint

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Objective The aim of this study was to investigate the effect of upper paratracheal lymph node (2R lymph node) resection on the prognosis of stage IB right lung cancer Methods We retrospectively collected data of 339 patients with stage IB right lung cancer who underwent radical surgery from 1999 to 2009. The prognostic factors were evaluated by Cox proportional hazard regression model. Propensity score matching (PSM) was applied to adjust the confounding factors. The Kaplan-Meier method was applied to evaluate overall survival (OS) and recurrence-free survival (RFS). Results For all 339 cases included in the study, Univariate and multivariate analysis showed that smoking and family history of malignant tumors were prognostic factors for OS. Age and family history of malignant tumors were prognostic factors for RFS. Resection of the 2R lymph node was not statistically associated with OS and RFS. All cases were separated into two groups based on whether the 2R lymph nodes were resected. The results of survival analysis after PSM also suggest that the resection of 2R lymph node is not statistically associated with OS and RFS (P > 0.05). Conclusions For stage IB right lung cancer, upper paratracheal lymph node resection was not statistically associated with OS or RFS. 2R lymph node resection may not be necessary for early-stage NSCLC.

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Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

Cited by 9 publications

References 20 publications

Prognosis and recurrence patterns in patients with early stage lung cancer: a multi-state model approach

Prognosis and recurrence patterns in patients with early stage lung cancer: a multi-state model approach

Evaluation of the necessity of Pulmonary Ligament Lymph Node Dissection for Upper Lobe Stage IB NSCLC: A Propensity Score-matched Study

Significance of upper paratracheal lymph node resection in stage IB right lung cancer

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