Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer
Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer
复制标题
I 期肺癌的最佳淋巴结检查和辅助化疗。
DOI：
10.1016/j.jtho.2019.03.027
复制
发表时间：
2019-07-01
影响因子：
20.4
通讯作者：
Zhang, Peng
中科院分区：
文献类型：
--
作者：
Dai, Jie;Liu, Ming;Zhang, Peng
目的：确定I期肺癌的最佳检查淋巴结数目和辅助化疗的作用。方法：检索2006-2014年间手术治疗的I期肺癌患者(N=65,438)。在多变量COX模型中确定了最佳的LN数目，并在临床I期疾病(N=117,112)的队列中进一步验证了LN数目的淋巴结转移和预后分层。在每个T分期中评估辅助化疗在分期不佳的患者中的作用(检查的淋巴结数目少于最佳数目)。结果：检查的淋巴结数目与肿瘤大小相关(p<；0.001)。每多检查一次LN，T1a、T1b、T1c和T2a患者的存活率就会增加，分别高达8、9、10和11个节点。来自临床分期疾病的队列的验证表明，8到11个淋巴结转移的阈值是淋巴结转移(OR=1.706，95%可信区间[CI]1.608-1.779)和生存结果(风险比=0.890，95%CI：0.865-0.916)的独立预测因子。经过倾向匹配后，辅助化疗与T2a分期不佳(风险比=0.841，95%CI：0.714-0.990)的患者的生存改善有关，但对T1a至T1c期的患者并不相关。结论：LN评估对于准确的分期和充分的治疗很重要，而且对于T成分逐渐升高的越来越多的淋巴结(即T1a、T1b、T1c和T2a肿瘤分别为8、9、10和11个节点)的检查似乎对预测升级和生存结果至关重要。辅助化疗对T2a期淋巴结分期不佳的患者可能是有益的。(C)2019年国际肺癌研究协会。爱思唯尔公司出版，版权所有。
Objective: To determine the optimal number of lymph nodes (LNs) examined and the role of adjuvant chemotherapy in stage I lung cancer.Methods: The National Cancer Database was queried for surgically treated patients with pathologic stage I lung cancer between 2006 and 2014 (N = 65,438). The optimal LN numbers were determined in the multivariate Cox model and were further validated in the cohort with clinical stage I disease (N = 117,112) in terms of nodal upstaging and prognostic stratification. The role of adjuvant chemotherapy in patients with suboptimal staging (number of LNs examined was less than than the optimum) was evaluated in each T stage.Results: The number of LNs examined correlated with tumor size (p < 0.001). There were increasing survival benefits with each additional LN examined-up to eight, nine, 10, and 11 nodes for patients with T1a, T1b, T1c, and T2a, respectively. Validation from the cohort with clinically staged disease showed that the threshold of eight to 11 LNs was an independent predictor of nodal upstaging (OR = 1.706, 95% confidence interval [CI] 1.608-1.779) and survival outcome (hazard ratio = 0.890, 95% CI: 0.865-0.916). After propensity matching, adjuvant chemotherapy was associated with improved survival in patients with stage T2a disease having suboptimal staging (hazard ratio = 0.841, 95% CI: 0.714-0.990), but not in patients with stage T1a to T1c disease.Conclusion: LN evaluation was important for accurate staging and adequate treatment, and examinations of an increasing number of nodes for progressively higher T components (i.e., eight, nine, 10, and 11 nodes for T1a, T1b, T1c, and T2a tumors, respectively) seemed crucial to predict upstaging and survival outcomes. Adjuvant chemotherapy might be beneficial to patients with stage T2a disease who have suboptimal nodal staging. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.