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. 2016 Mar;8(3):342-9.
doi: 10.21037/jtd.2016.02.49.

Mediastinal lymphadenectomy fulfilling NCCN criteria may improve the outcome of clinical N0-1 and pathological N2 non-small cell lung cancer

Xing Wang  1 , Shi Yan  1 , Kevin Phan  1 , Tristan D Yan  1 , Lijian Zhang  1 , Yue Yang  1 , Nan Wu  1
Affiliations

Mediastinal lymphadenectomy fulfilling NCCN criteria may improve the outcome of clinical N0-1 and pathological N2 non-small cell lung cancer

Xing Wang et al. J Thorac Dis. 2016 Mar.

Abstract

Background: This retrospective study investigated whether mediastinal lymphadenectomy compliant with the National Comprehensive Cancer Network (NCCN) criteria will improve the oncological outcomes of clinical early-stage lung cancer.

Methods: From 2003-2010, 712 consecutive cases of clinical N0/1 were included for retrospective analysis, including 152 confirmed cases of pN2 and 560 of pN0-1 disease following surgery. Group A was defined as the cases fulfilling NCCN lymphadenectomy criteria (≥ three stations of N2 nodes dissection) and group B included all other cases. The groups were stratified according to pN status and the outcomes were assessed.

Results: Five-year overall survival (OS) and 5-year disease-free survival (DFS) were significantly different between group A versus B [72%±2% vs. 63%±4% (OS), P=0.014; 58.0%±2% vs. 49%±4% (DFS), P=0.038] in the whole cohort. After stratification by pN status, this difference was remained in pN2 subgroup [50%±5% vs. 25%±9% (OS), P=0.006; 31.0%±4% vs. 13%±7% (DFS), P=0.014], but not in pN0-1 subgroups. Cox regression analysis showed that performing a lymphadenectomy fulfilling NCCN criteria was a significant prognostic factor for OS either in the whole cohort [P=0.003, hazard ratio (HR): 0.598, 95% confidence interval (CI): 0.425-0.841] or in patients of pN2 status (P=0.038, HR: 0.559, 95% CI: 0.323-0.968). Cases with ≥4 N2 stations dissected did not achieve better survival benefit compared to those harvesting 3 stations in cN0/1-pN2 group (P=0.152).

Conclusions: Mediastinal lymphadenectomy fulfilling NCCN criteria appears to improve the survival of unexpected N2 group (cN0/1-pN2) among early-stage lung cancer patients. More extended N2 node dissection may not further improve the outcome in this group.

Keywords: Lung cancer; lymphadenectomy; outcome.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Overall survival and disease-free survival between group A and group B in the whole cohort for clinical N0/1 non-small cell lung cancer.
Figure 2
Figure 2
Overall survival (A, B, C) and disease-free survival (D, E, F) between group A and group B stratified by pathological N status for clinical N0/1 non-small cell lung cancer.
Figure 3
Figure 3
Overall survival (A) and disease-free survival (B) between patients with three stations collection and more than three stations collection.
See this image and copyright information in PMC

References

    1. Ettinger DS, Kris MG. Update: NCCN non-small cell lung cancer clinical practice guidelines. J Natl Compr Canc Netw 2004;2 Suppl 3:S-9-13. - PubMed
    1. Wu Y, Huang ZF, Wang SY, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer 2002;36:1-6. 10.1016/S0169-5002(01)00445-7 - DOI - PubMed
    1. Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg 2011;141:662-70. 10.1016/j.jtcvs.2010.11.008 - DOI - PMC - PubMed
    1. Vallières E, Shepherd FA, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2009;4:1049-59. 10.1097/JTO.0b013e3181b27799 - DOI - PubMed
    1. Darling GE, Allen MS, Decker PA, et al. Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective American College of Surgeons Oncology Group Z0030 trial. Chest 2011;139:1124-9. 10.1378/chest.10-0859 - DOI - PMC - PubMed

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