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. 2014 Feb;97(2):385-93.
doi: 10.1016/j.athoracsur.2013.09.058. Epub 2013 Nov 20.

Number of lymph nodes associated with maximal reduction of long-term mortality risk in pathologic node-negative non-small cell lung cancer

Raymond U Osarogiagbon  1 , Obiageli Ogbata  2 , Xinhua Yu  3
Affiliations

Number of lymph nodes associated with maximal reduction of long-term mortality risk in pathologic node-negative non-small cell lung cancer

Raymond U Osarogiagbon et al. Ann Thorac Surg. 2014 Feb.

Abstract

Background: Forty-four percent of patients with pathologic node negative (pN0) non-small cell lung cancer (NSCLC) die within 5 years of curative-intent surgical procedures. Heterogeneity in pathologic nodal examination practice raises concerns about the accuracy of nodal staging in these patients. We hypothesized a reciprocal relationship between the number of lymph nodes examined and the probability of missed lymph node metastasis and sought to identify the number of lymph nodes associated with the lowest mortality risk in pN0 NSCLC.

Methods: We analyzed resections for first primary pN0 NSCLC in the United States Surveillance, Epidemiology, and End Results (SEER) database from 1998 to 2009, with survival updated to December 31, 2009.

Results: In 24,650 eligible patients, there was a significant sequential reduction in mortality risk with examination of more lymph nodes. The lowest mortality risk occurred in those with 18 to 21 lymph nodes examined. The hazard ratio for all-cause mortality was 0.65 and the 95% confidence interval (CI) was 0.57 to 0.73; for lung cancer-specific mortality, hazard ratio was 0.62 and CI was 0.53 to 0.73 (p<0.001 for both). The median number of lymph nodes examined was only 6.

Conclusions: Lymph node evaluation falls far short of optimal in patients with resected pN0 NSCLC, raising the odds of underestimation of long-term mortality risk and failure to identify candidates for postoperative adjuvant therapy. This represents a major quality gap for which corrective intervention is warranted.

Keywords: 10.

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Figures

Figure 1
Figure 1
Selection of study cohort.
Figure 2
Figure 2
Distribution of number of lymph nodes examined in patients with resected pathologic node-negative non-small cell lung cancer: US Surveillance, Epidemiology and End Results database, 1998 to 2009.
Figure 3
Figure 3
Evolution of hazard ratio for mortality with the number of lymph nodes examined. A) All-cause mortality. B) Lung cancer-specific mortality.
Figure 3
Figure 3
Evolution of hazard ratio for mortality with the number of lymph nodes examined. A) All-cause mortality. B) Lung cancer-specific mortality.
Figure 4
Figure 4
Evolution of hazard ratio for mortality with the number of lymph nodes examined in lobectomy cases.
Figure 5
Figure 5
Trend analysis of the number of lymph nodes examined in resected pathologic node-negative non-small cell lung cancer: US Surveillance, Epidemiology and End Results database, 1998 to 2009.
See this image and copyright information in PMC

Comment in

  • Invited commentary.
    Rusch VW. Rusch VW. Ann Thorac Surg. 2014 Feb;97(2):393. doi: 10.1016/j.athoracsur.2013.10.075. Ann Thorac Surg. 2014. PMID: 24484783 No abstract available.
  • Prognostic stratification of node-negative NSCLC patients: is it worthwhile?
    Leuzzi G, Bria E, Alessandrini G, Forcella D, Facciolo F. Leuzzi G, et al. Ann Thorac Surg. 2014 Oct;98(4):1527. doi: 10.1016/j.athoracsur.2014.04.112. Ann Thorac Surg. 2014. PMID: 25282241 No abstract available.
  • Reply: To PMID 24266949.
    Osarogiagbon RU. Osarogiagbon RU. Ann Thorac Surg. 2014 Oct;98(4):1527-8. doi: 10.1016/j.athoracsur.2014.07.014. Ann Thorac Surg. 2014. PMID: 25282242 No abstract available.

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