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

Background: A surgical lung resection with systematic mediastinal lymph node (LN) dissection is recommended by the National Comprehensive Cancer Network guideline. However, the effective number of dissected LNs, stations and positivity is still controversial. The aim of this study is to identify the...

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Main Authors: Apichat Tantraworasin, Somcharoen Saeteng, Sophon Siwachat, Tawatchai Jiarawasupornchai, Nirush Lertprasertsuke, Sarawut Kongkarnka, Chidchanok Ruengorn, Jayanton Patumanond, Emanuela Taioli, Raja M. Flores
Format: Journal
Published: 2018
Online Access:https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85016503744&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/47222
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Institution: Chiang Mai University
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spelling th-cmuir.6653943832-472222018-04-25T07:26:57Z Impact of lymph node management on resectable non-small cell lung cancer patients Apichat Tantraworasin Somcharoen Saeteng Sophon Siwachat Tawatchai Jiarawasupornchai Nirush Lertprasertsuke Sarawut Kongkarnka Chidchanok Ruengorn Jayanton Patumanond Emanuela Taioli Raja M. Flores Background: A surgical lung resection with systematic mediastinal lymph node (LN) dissection is recommended by the National Comprehensive Cancer Network guideline. However, the effective number of dissected LNs, stations and positivity is still controversial. The aim of this study is to identify the impact of total numbers, LN stations and positivity of dissected LNs on tumor recurrence and overall death in resectable non-small cell lung cancer (NSCLC). Methods: This prognostic study used a retrospective data collection design. Adult patients with clinical resectable NSCLC who underwent pulmonary resection and mediastinal lymphadenectomy at Chiang Mai University between June 2000 and June 2012 were enrolled in this study. A multilevel mixed-effects parametric survival model was used to identify the effect of numbers, LN stations and positivity of dissected LNs to tumor recurrence and mortality. 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. 2018-04-25T07:26:57Z 2018-04-25T07:26:57Z 2017-03-01 Journal 20776624 20721439 2-s2.0-85016503744 10.21037/jtd.2017.02.90 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85016503744&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/47222
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
description Background: A surgical lung resection with systematic mediastinal lymph node (LN) dissection is recommended by the National Comprehensive Cancer Network guideline. However, the effective number of dissected LNs, stations and positivity is still controversial. The aim of this study is to identify the impact of total numbers, LN stations and positivity of dissected LNs on tumor recurrence and overall death in resectable non-small cell lung cancer (NSCLC). Methods: This prognostic study used a retrospective data collection design. Adult patients with clinical resectable NSCLC who underwent pulmonary resection and mediastinal lymphadenectomy at Chiang Mai University between June 2000 and June 2012 were enrolled in this study. A multilevel mixed-effects parametric survival model was used to identify the effect of numbers, LN stations and positivity of dissected LNs to tumor recurrence and mortality. 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.
format Journal
author Apichat Tantraworasin
Somcharoen Saeteng
Sophon Siwachat
Tawatchai Jiarawasupornchai
Nirush Lertprasertsuke
Sarawut Kongkarnka
Chidchanok Ruengorn
Jayanton Patumanond
Emanuela Taioli
Raja M. Flores
spellingShingle Apichat Tantraworasin
Somcharoen Saeteng
Sophon Siwachat
Tawatchai Jiarawasupornchai
Nirush Lertprasertsuke
Sarawut Kongkarnka
Chidchanok Ruengorn
Jayanton Patumanond
Emanuela Taioli
Raja M. Flores
Impact of lymph node management on resectable non-small cell lung cancer patients
author_facet Apichat Tantraworasin
Somcharoen Saeteng
Sophon Siwachat
Tawatchai Jiarawasupornchai
Nirush Lertprasertsuke
Sarawut Kongkarnka
Chidchanok Ruengorn
Jayanton Patumanond
Emanuela Taioli
Raja M. Flores
author_sort Apichat Tantraworasin
title Impact of lymph node management on resectable non-small cell lung cancer patients
title_short Impact of lymph node management on resectable non-small cell lung cancer patients
title_full Impact of lymph node management on resectable non-small cell lung cancer patients
title_fullStr Impact of lymph node management on resectable non-small cell lung cancer patients
title_full_unstemmed Impact of lymph node management on resectable non-small cell lung cancer patients
title_sort impact of lymph node management on resectable non-small cell lung cancer patients
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85016503744&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/47222
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