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Comparative Study
. 2017 May;265(5):1025-1033.
doi: 10.1097/SLA.0000000000001802.

Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

Raja M Flores  1 , Daniel Nicastri, Thomas Bauer, Ralph Aye, Shahriyour Andaz, Leslie Kohman, Barry Sheppard, William Mayfield, Richard Thurer, Robert Korst, Michaela Straznicka, Fred Grannis, Harvey Pass, Cliff Connery, Rowena Yip, James P Smith, David F Yankelevitz, Claudia I Henschke, Nasser K Altorki; Writing committee for the I-ELCAP Investigators
Affiliations
Comparative Study

Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

Raja M Flores et al. Ann Surg. 2017 May.

Abstract

Objective: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014.

Background: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules.

Methods: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates.

Results: The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4-3.8), centrally located tumor (HR 2.5, 95% CI 1.2-5.2), tumor size 21 to 30 mm (HR 2.7, 95% CI 1.2-6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4-6.1). For the 346 patients with MLNR, tumor size was 20 mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24).

Conclusions: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.

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Figures

FIGURE 1
FIGURE 1
Kaplan-Meier lung cancer survival cure for 607 patients with clinical N0M0 nonsmall cell lung cancer manifesting either as a solid or subsolid nodule: patients with MLNR (n = 462) and without MLNR (n = 145). Median pathology tumor size was 13 mm in both groups.
FIGURE 2
FIGURE 2
The hazard ratio (HR) of the risk for dying of clinical stage I nonsmall cell lung cancer (cN0M0) manifesting as a solid nodule for patients who had MLNR as compared with the reference group of patients who did not have MLNR.
See this image and copyright information in PMC

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References

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