The extent of mediastinal lymph node dissection correlates with survival of small cell lung cancer patients after resection: a propensity score-matched cohort study analysis

Abstract

Background Evidence on the importance of lymph node (LN) dissection during resection for small cell lung cancer (SCLC) is scarce. This study sought to investigate the clinical impact of the extent of lymphadenectomy on the survival of patients with SCLC. Methods Patients who underwent resection for primary SCLC between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) cancer registry. The patients were stratified based on the number of LNs dissected (0, 1–3, 4–11, and ≥12) via an X-Tile software analysis, and lung cancer-specific survival (LCSS) and overall survival (OS) were compared between these stratified groups using Kaplan-Meier curves. A propensity score-matched analysis and a Cox regression model were used to adjust for potential confounders. Results A total of 1,883 patients with SCLC met our criteria and were enrolled in the study. The LCSS and OS analyses revealed that patients who underwent LN dissection during surgery had longer survival times significantly than patients who did not. Similarly, patients who underwent more extensive LN dissection (≥4 LNs) had longer survival times than those who underwent less extensive LN dissection (1–3 LNs). However, no significant increase in survival time was found for patients who underwent the dissection of ≥12 LNs compared to those who underwent the dissection of 4–11 LNs. These results were confirmed in our propensity-matched and Cox regression analyses. Conclusions Our study revealed that patient survival after surgical resection for SCLC is associated with the number of dissected LNs, and the number of LNs for dissection ranges from 4 to 11 achieve the best survival outcome.

Prognostic Relevance of Negative Lymph Node Count in Resected Stage I–IIIa Small-cell Lung Cancer

“…In the clinic, LN dissection is a key component of radical resection. Precise detection and thorough dissection of metastatic LNs are important for improving the survival of patients with resected SCLC 25–27 . Adequate LN dissection can not only ensure radical resection of the tumor and reduce postoperative recurrence but also provides important bases for accurate pathologic staging and the selection of subsequent adjuvant therapy 26–28 .…”

“…Precise detection and thorough dissection of metastatic LNs are important for improving the survival of patients with resected SCLC. [25][26][27] Adequate LN dissection can not only ensure radical resection of the tumor and reduce postoperative recurrence but also provides important bases for accurate pathologic staging and the selection of subsequent adjuvant therapy. [26][27][28] In the current TNM staging system, the N stage is graded according to the anatomic site of LN invasion; however, the anatomic position of LN…”

Prognostic value of L4 lymph node dissection during video-assisted thoracoscopic surgery in patients with left-sided non-small cell lung cancer: a single-center, retrospective cohort study

“…The cornerstone of NSCLC treatment remains surgical pulmonary resection with systemic lymphadenectomy. The rate of lymph node metastasis in patients with NSCLC is 30-40% (3), so systemic lymph node dissection (LND) during radical resection is crucial for staging and prognosis (4)(5)(6). In current guidelines, it is recommended to excise at least three mediastinal nodal stations (including subcarinal stations) as a minimum requirement, but no recommendations are detailed for the excision of left lower paratracheal (L4) lymph nodes in patients with left-sided NSCLC (7)(8)(9).…”