Nonexamination of Lymph Nodes and Survival After Resection of Non-Small Cell Lung Cancer
Nonexamination of Lymph Nodes and Survival After Resection of Non-Small Cell Lung Cancer
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DOI：
10.1016/j.athoracsur.2013.05.021
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发表时间：
2013-10-01
影响因子：
4.6
通讯作者：
Yu, Xinhua
中科院分区：
文献类型：
--
作者：
Osarogiagbon, Raymond U.;Yu, Xinhua
背景。未检查淋巴结是非小细胞肺癌病理分期变异性的一个极端例子。我们比较了无淋巴结（pNX）患者与病理性N0和病理性N1非小细胞肺癌患者的患病率、特征和生存率。回顾性分析了1998年至2009年美国监测、流行病学和最终结果数据库中非小细胞肺癌切除术的病例。13%的切除术（18%的淋巴结阴性切除术）为pNX，包括6%的淋巴结阴性或更大淋巴结切除术和51%的叶下切除术。35%的pNX切除术为大叶或更大，而90%的病理N0 （p < 0.0001）。高龄和农村地区的手术也与pNX切除术显著相关。pNX组的中位生存期为3年，N0组为6.4年（p < 0.0001）， n1组为2.8年，5年生存率分别为47%、67%和45% （p < 0.0001）。在排除潜在的混杂因素后，这些生存差异仍然存在。pNX切除术的患者是一个高危亚群，其生存率接近病理N1，而不是N0。患者应进一步尝试取淋巴结进行检查或术后给予辅助化疗。我们预测，与进行适当淋巴结检查的手术相比，未能处理淋巴结的治疗方式可能产生较差的生存率。pNX肺切除术的比例可能是肺癌项目的哨点质量指标。(C) 2013年由胸外科学会发布
Background. Nonexamination of lymph nodes is an extreme example of the variability of pathologic nodal staging of non-small cell lung cancer. We compared the prevalence, characteristics, and survival of patients without lymph nodes (pNX) to patients with documented pathologic N0 and pathologic N1 non-small cell lung cancer.Methods. A retrospective analysis was done of non-small cell lung cancer resections in the US Surveillance, Epidemiology, and End Results database from 1998 to 2009.Results. Thirteen percent of all resections (18% of node negative resections) were pNX, including 6% of all node-negative lobar or greater resections and 51% of sublobar resections. Thirty-five percent of pNX resections were lobar or greater compared with 90% of pathologic N0 (p < 0.0001). Advanced age and surgery in rural locations were also significantly associated with pNX resection. The median duration of survival was 3 years in the pNX cohort, 6.4 years in the N0 cohort (p < 0.0001), and 2.8 years in the N1group, with respective 5-year survival rates of 47%, 67%, and 45% (p < 0.0001). These survival differences remained after adjustment for potentially confounding factors.Conclusions. Patients with pNX resections are a high-risk subset, with survival approximating pathologic N1, not N0. They should have further attempts at retrieving lymph nodes for examination or be offered postoperative adjuvant chemotherapy. We predict that treatment modalities that fail to address lymph nodes are likely to yield inferior survival in comparison to surgery with proper lymph node examination. The proportion of pNX lung resections may be a sentinel quality indicator for lung cancer programs. (C) 2013 by The Society of Thoracic Surgeons