A large real-world cohort study of examined lymph node standards for adequate nodal staging in early non-small cell lung cancer

作者：Zhu, Zhihua; Song, Zhengbo; Jiao, Wenjie; Mei, Weijian; Xu, Chunwei; Huang, Qinghua; An, Chaolun; Shi, Jianguang; Wang, Wenxian; Yu, Guiping; Sun, Pingli; Zhang, Yinbin; Shen, Jianfei; Song, Yong; Qian, Jun^*; Yao, Wang^*; Yang, Han^*

来源：Translational Lung Cancer Research, 2021, 10(2): 815-+.

DOI：10.21037/tlcr-20-1024

• Non-small cell lung cancer (NSCLC)
• examined lymph node (ELN)
• minimal number
• nodal staging
• cohort study

Background: The current National Comprehensive Cancer Network (NCCN) guidelines for non-small cell lung cancer (NSCLC) recommend that surgeons sample is not clear. We aimed to define a minimal number of examined lymph nodes for removal or sampling for optimized nodal staging recommendation, with a focus on T1-3N0M0 patients. @@@ Methods: A total of 55,101 consecutive patients were selected, including 52,099 patients with US Surveillance, Epidemiology, and End Results (SEER) data and 3,002 patients in a Chinese multicenter database from 11 thoracic referral centers, who underwent complete resection plus lymph node dissection or sampling for stage T1-3N0M0 NSCLC. Propensity score-matching analysis was performed with R software, and a cut-off value was calculated using X-tile software. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard models. @@@ Results: Five-year survival rates with respect to total examined lymph nodes numbers (examined lymph nodes <10 vs. examined lymph nodes >= 10) were 69% and 64% (group A), 66% and 63% (group B), 62% and 58% (group C), 81% and 75% (group D). There were significant differences between examined lymph nodes 10 and examined lymph nodes 10 in each group (P<0.001). @@@ Conclusions: A minimum of 10 examined lymph nodes would significantly improve T1-3N0M0 NSCLC prognosis and patients' survival rates if implemented as a minimum standard for lymphadenectomy. Therefore, we recommended a minimum of 10 examined lymph nodes for T1-3N0M0 patients.

• 单位
  中山大学; 浙江大学; 南京大学; 南方医科大学; 西安交通大学; 南通大学; 中国科学院研究生院; 吉林大学; 青岛大学