A large real-world cohort study of examined lymph node standards for adequate nodal staging in early non-small cell lung cancer.
A large real-world cohort study of examined lymph node standards for adequate nodal staging in early non-small cell lung cancer.
复制标题
早期非小细胞肺癌淋巴结分期标准的大型真实世界队列研究
DOI：
10.21037/tlcr-20-1024
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发表时间：
2021-03
影响因子：
4
通讯作者：
written on behalf of AME Lung Cancer Collaborative Group
中科院分区：
文献类型：
--
作者：
Zhu Z;Song Z;Jiao W;Mei W;Xu C;Huang Q;An C;Shi J;Wang W;Yu G;Sun P;Zhang Y;Shen J;Song Y;Qian J;Yao W;Yang H;written on behalf of AME Lung Cancer Collaborative Group
目前国家综合癌症网络（NCCN）非小细胞肺癌（NSCLC）指南建议外科医生样本不明确。我们的目的是确定最少数量的检查淋巴结，用于切除或采样，以优化淋巴结分期建议，重点关注T1- 3 N 0 M0患者。共选择了55，101例连续患者，包括52，099例具有美国监测、流行病学和最终结果（SEER）数据的患者和3，002例来自11个胸部转诊中心的中国多中心数据库中的患者，这些患者接受了T1- 3 N 0 M0期NSCLC的完全切除加淋巴结清扫或采样。用R软件进行倾向评分匹配分析，并使用X-tile软件计算临界值。采用Kaplan-Meier法和考克斯比例风险模型评价生存率。总淋巴结数（淋巴结数<10 vs ≥10）的5年生存率分别为69%和64%（A组）、66%和63%（B组）、62%和58%（C组）、81%和75%（D组）。各组10个淋巴结之间有显著性差异<10 and examined lymph nodes >（P<0.001）。如果作为淋巴结清扫的最低标准，至少检查10个淋巴结将显著改善T1- 3 N 0 M0 NSCLC预后和患者生存率。因此，我们建议T1- 3 N 0 M0患者至少检查10个淋巴结。
The current National Comprehensive Cancer Network (NCCN) guidelines for non-small cell lung cancer (NSCLC) recommend that surgeons sample is not clear. We aimed to define a minimal number of examined lymph nodes for removal or sampling for optimized nodal staging recommendation, with a focus on T1–3N0M0 patients. A total of 55,101 consecutive patients were selected, including 52,099 patients with US Surveillance, Epidemiology, and End Results (SEER) data and 3,002 patients in a Chinese multicenter database from 11 thoracic referral centers, who underwent complete resection plus lymph node dissection or sampling for stage T1–3N0M0 NSCLC. Propensity score-matching analysis was performed with R software, and a cut-off value was calculated using X-tile software. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard models. Five-year survival rates with respect to total examined lymph nodes numbers (examined lymph nodes <10 vs. examined lymph nodes ≥10) were 69% and 64% (group A), 66% and 63% (group B), 62% and 58% (group C), 81% and 75% (group D). There were significant differences between examined lymph nodes <10 and examined lymph nodes >10 in each group (P<0.001). A minimum of 10 examined lymph nodes would significantly improve T1–3N0M0 NSCLC prognosis and patients’ survival rates if implemented as a minimum standard for lymphadenectomy. Therefore, we recommended a minimum of 10 examined lymph nodes for T1–3N0M0 patients.