Mediastinal Lymph Node Examination and Survival in Resected Early-Stage Non-Small-Cell Lung Cancer in the Surveillance, Epidemiology, and End Results Database
Mediastinal Lymph Node Examination and Survival in Resected Early-Stage Non-Small-Cell Lung Cancer in the Surveillance, Epidemiology, and End Results Database
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DOI：
10.1097/jto.0b013e31827457db
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发表时间：
2012-12-01
影响因子：
20.4
通讯作者：
Yu, Xinhua
中科院分区：
文献类型：
--
作者：
Osarogiagbon, Raymond U.;Yu, Xinhua
背景：病理淋巴结分期是可切除非小细胞肺癌（NSCLC）的关键预后因素。纵隔淋巴结（MLN）转移意味着预后不良。然而，一些非小细胞肺癌切除术不包括MLN检查。方法：我们分析了1998年至2002年美国监测、流行病学和最终结果项目的数据，以量化未检查MLN对切除NSCLC的长期生存的影响。我们使用Kaplan-Meier方法比较接受和未接受MLN检查的患者之间的未调整生存差异，并使用Cox比例风险和竞争风险模型来连续调整危险因素对生存差异的影响。结果：62%的病理性N0或N1 NSCLC患者未检查MLN。接受MLN检查的患者5年总体生存率为52%，未接受MLN检查的患者为47%；肺癌特异性生存率分别为63%和58% (p < 0.001)；非肺癌死亡率在队列之间是相同的。调整潜在混杂因素后，MLN检查与全因死亡率降低7%（风险比，0.93；可信区间，0.88-0.97;p = 0.002）和肺癌特异性死亡率降低11%（风险比，0.89；95%可信区间，0.84-0.95;p < 0.001）相关。在美国进行1年肺切除术的队列中，5年内的额外风险为3150人。结论：未能检查MLN是MLN阴性NSCLC切除术的常见做法，这显著损害了长期生存。努力了解这种质量差距的病因，并采取措施消除它，是必要的。
Background: Pathologic nodal stage is the key prognostic factor in resectable non-small-cell lung cancer (NSCLC). Mediastinal lymph node (MLN) metastasis connotes a poor prognosis. Yet, some NSCLC resections exclude MLN examination.Methods: We analyzed U.S. Surveillance, Epidemiology, and End Results program data from 1998 to 2002 to quantify the long-term survival impact of failure to examine MLN in resected NSCLC. We used Kaplan-Meier methods to compare the unadjusted survival difference between patients with, and without, MLN examination, and Cox proportional hazards and competing risk models to serially adjust for the impact of risk factors on survival differences.Results: Sixty-two percent of patients with pathologic N0 or N1 NSCLC had no MLN examined. Overall 5-year survival rates were 52% for those with, versus 47% for those without, MLN examination; lung cancer-specific survival rates were 63% versus 58% respectively (p < 0.001); nonlung cancer mortality was identical between cohorts. Adjusting for potential confounders, MLN examination was associated with a 7% reduction in all-cause mortality (hazard ratio, 0.93; confidence interval, 0.88-0.97; p = 0.002), and 11% reduction in lung cancer-specific mortality (hazard ratio, 0.89; 95% confidence interval, 0.84-0.95; p < 0.001) rates. The excess risk in 1 year's cohort of U. S. lung resections was 3150 lives over 5 years.Conclusions: Failure to examine MLN was a common practice in MLN-negative NSCLC resections, which significantly impaired long-term survival. Efforts to understand the etiology of this quality gap, and measures to eliminate it, are warranted.