Does Lymph Node Count Influence Survival in Surgically Resected Non-Small Cell Lung Cancer?

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Abstract

Background: The prognostic significance of the number of lymph nodes sampled (NLNS) during resection for non-small cell lung cancer (NSCLC) is unclear. The NLNS is influenced by many factors, and some have argued that it should be a surrogate for quality. We sought to determine the influence of the NLNS on overall survival and cancer-specific survival for surgically resected NSCLC. Methods: The California Cancer Registry was queried from 2004 to 2011 for cases of stage I to III NSCLC treated with surgical resection, identifying 16,393 patients. Kaplan-Meier and Cox proportional hazards modeling were used to determine the influence of NLNS on overall survival and cancer-specific survival. Results: In all, 15,195 patients had information regarding nodal sampling. Eighty percent (13,167 of 15,195) were treated with lobectomy. Patients who were younger, male, non-Hispanic white, highest socioeconomic status, higher stage, or larger size tumor had more nodes removed. Sampling fewer than 10 nodes was associated with poorer overall survival when compared with sampling 10 or more nodes after adjustment for demographic and clinical factors for stage I: overall survival hazard ratio 1.78 (95% confidence interval: 1.54 to 2.05, . p < 0.0001), hazard ratio 1.43 (95% confidence interval: 1.27 to 1.59, . p < 0.0001), and hazard ratio 1.16 (95% confidence interval: 1.05 to 1.28, . p = 0.004), for 0, 1 to 3, and 4 to 10 nodes, respectively. Of patients who underwent sublobar resection, 43.8% had no nodes sampled. Conclusions: For NSCLC, the NLNS influenced both overall survival and cancer-specific survival, but the influence is dependent on stage. Surgeons should perform mediastinal lymphadenectomy to maximize patient survival, but the optimal NLNS remains unclear.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2016

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Non-Small Cell Lung Carcinoma
Lymph Nodes
Survival
Confidence Intervals
Neoplasms
Lymph Node Excision
Social Class
Registries
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

@article{dd1ce25c9d354e66898aa3e9e7e7da35,
title = "Does Lymph Node Count Influence Survival in Surgically Resected Non-Small Cell Lung Cancer?",
abstract = "Background: The prognostic significance of the number of lymph nodes sampled (NLNS) during resection for non-small cell lung cancer (NSCLC) is unclear. The NLNS is influenced by many factors, and some have argued that it should be a surrogate for quality. We sought to determine the influence of the NLNS on overall survival and cancer-specific survival for surgically resected NSCLC. Methods: The California Cancer Registry was queried from 2004 to 2011 for cases of stage I to III NSCLC treated with surgical resection, identifying 16,393 patients. Kaplan-Meier and Cox proportional hazards modeling were used to determine the influence of NLNS on overall survival and cancer-specific survival. Results: In all, 15,195 patients had information regarding nodal sampling. Eighty percent (13,167 of 15,195) were treated with lobectomy. Patients who were younger, male, non-Hispanic white, highest socioeconomic status, higher stage, or larger size tumor had more nodes removed. Sampling fewer than 10 nodes was associated with poorer overall survival when compared with sampling 10 or more nodes after adjustment for demographic and clinical factors for stage I: overall survival hazard ratio 1.78 (95{\%} confidence interval: 1.54 to 2.05, . p < 0.0001), hazard ratio 1.43 (95{\%} confidence interval: 1.27 to 1.59, . p < 0.0001), and hazard ratio 1.16 (95{\%} confidence interval: 1.05 to 1.28, . p = 0.004), for 0, 1 to 3, and 4 to 10 nodes, respectively. Of patients who underwent sublobar resection, 43.8{\%} had no nodes sampled. Conclusions: For NSCLC, the NLNS influenced both overall survival and cancer-specific survival, but the influence is dependent on stage. Surgeons should perform mediastinal lymphadenectomy to maximize patient survival, but the optimal NLNS remains unclear.",
author = "Elizabeth David and Cooke, {David T} and Yingjia Chen and Kieranjeet Nijar and Canter, {Robert J} and Cress, {Rosemary D}",
year = "2016",
doi = "10.1016/j.athoracsur.2016.05.018",
language = "English (US)",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Does Lymph Node Count Influence Survival in Surgically Resected Non-Small Cell Lung Cancer?

AU - David, Elizabeth

AU - Cooke, David T

AU - Chen, Yingjia

AU - Nijar, Kieranjeet

AU - Canter, Robert J

AU - Cress, Rosemary D

PY - 2016

Y1 - 2016

N2 - Background: The prognostic significance of the number of lymph nodes sampled (NLNS) during resection for non-small cell lung cancer (NSCLC) is unclear. The NLNS is influenced by many factors, and some have argued that it should be a surrogate for quality. We sought to determine the influence of the NLNS on overall survival and cancer-specific survival for surgically resected NSCLC. Methods: The California Cancer Registry was queried from 2004 to 2011 for cases of stage I to III NSCLC treated with surgical resection, identifying 16,393 patients. Kaplan-Meier and Cox proportional hazards modeling were used to determine the influence of NLNS on overall survival and cancer-specific survival. Results: In all, 15,195 patients had information regarding nodal sampling. Eighty percent (13,167 of 15,195) were treated with lobectomy. Patients who were younger, male, non-Hispanic white, highest socioeconomic status, higher stage, or larger size tumor had more nodes removed. Sampling fewer than 10 nodes was associated with poorer overall survival when compared with sampling 10 or more nodes after adjustment for demographic and clinical factors for stage I: overall survival hazard ratio 1.78 (95% confidence interval: 1.54 to 2.05, . p < 0.0001), hazard ratio 1.43 (95% confidence interval: 1.27 to 1.59, . p < 0.0001), and hazard ratio 1.16 (95% confidence interval: 1.05 to 1.28, . p = 0.004), for 0, 1 to 3, and 4 to 10 nodes, respectively. Of patients who underwent sublobar resection, 43.8% had no nodes sampled. Conclusions: For NSCLC, the NLNS influenced both overall survival and cancer-specific survival, but the influence is dependent on stage. Surgeons should perform mediastinal lymphadenectomy to maximize patient survival, but the optimal NLNS remains unclear.

AB - Background: The prognostic significance of the number of lymph nodes sampled (NLNS) during resection for non-small cell lung cancer (NSCLC) is unclear. The NLNS is influenced by many factors, and some have argued that it should be a surrogate for quality. We sought to determine the influence of the NLNS on overall survival and cancer-specific survival for surgically resected NSCLC. Methods: The California Cancer Registry was queried from 2004 to 2011 for cases of stage I to III NSCLC treated with surgical resection, identifying 16,393 patients. Kaplan-Meier and Cox proportional hazards modeling were used to determine the influence of NLNS on overall survival and cancer-specific survival. Results: In all, 15,195 patients had information regarding nodal sampling. Eighty percent (13,167 of 15,195) were treated with lobectomy. Patients who were younger, male, non-Hispanic white, highest socioeconomic status, higher stage, or larger size tumor had more nodes removed. Sampling fewer than 10 nodes was associated with poorer overall survival when compared with sampling 10 or more nodes after adjustment for demographic and clinical factors for stage I: overall survival hazard ratio 1.78 (95% confidence interval: 1.54 to 2.05, . p < 0.0001), hazard ratio 1.43 (95% confidence interval: 1.27 to 1.59, . p < 0.0001), and hazard ratio 1.16 (95% confidence interval: 1.05 to 1.28, . p = 0.004), for 0, 1 to 3, and 4 to 10 nodes, respectively. Of patients who underwent sublobar resection, 43.8% had no nodes sampled. Conclusions: For NSCLC, the NLNS influenced both overall survival and cancer-specific survival, but the influence is dependent on stage. Surgeons should perform mediastinal lymphadenectomy to maximize patient survival, but the optimal NLNS remains unclear.

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U2 - 10.1016/j.athoracsur.2016.05.018

DO - 10.1016/j.athoracsur.2016.05.018

M3 - Article

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

ER -