Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients
Background The benefit of thoracic lymphadenectomy in the treatment of resectable non-small cell lung cancer (NSCLC) continues to be debated. We hypothesized that the number of lymph nodes (LNs) removed for patients with pathologic node-negative NSCLC would correlate with survival. Methods The Natio...
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| Veröffentlicht in: | Annals of surgical oncology 2016-12, Vol.23 (Suppl 5), p.1005-1011 |
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| container_title | Annals of surgical oncology |
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| creator | Samayoa, Andres X. Pezzi, Todd A. Pezzi, Christopher M. Greer Gay, E. Asai, Megumi Kulkarni, Nandini Carp, Ned Chun, Stephen G. Putnam, Joe B. |
| description | Background
The benefit of thoracic lymphadenectomy in the treatment of resectable non-small cell lung cancer (NSCLC) continues to be debated. We hypothesized that the number of lymph nodes (LNs) removed for patients with pathologic node-negative NSCLC would correlate with survival.
Methods
The National Cancer Data Base (NCDB) was queried for resected, node-negative, NSCLC patients treated between 2004 and 2014. Patients were grouped according to the number of LNs removed (1–4, 5–8, 9–12, 13–16, and ≥17). Patients with |
| doi_str_mv | 10.1245/s10434-016-5509-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1852655508</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1852655508</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-4bda1bb675ce0b25a2790077b83d794e4fe8e1dfff2a597ebff27371a8434bc53</originalsourceid><addsrcrecordid>eNp1UcFu1TAQtBCIlsIHcEGWuHBowE7s2OGGIgpIj4Je4WzZyaZNFduvdvJQP4m_ZKNXUIXgYq92Z2a1M4Q85-w1L4V8kzkTlSgYrwspWVOIB-SYS-yIWvOHWLNaF01ZyyPyJOdrxriqmHxMjkolK14xdUx-bu08xmAnoENM1NLPYxj94un54h0kGge6ufW7K3oee8h0Cz7uoac_xnltheLC22miLeCzWcIlbW3okLaFDN0q_Ja2MSWYcAtO5yu4J_wPyYsl7ce9negYaKNPG8XoV6RCmPNT8miwU4Znd_8J-X72_lv7sdh8-fCpfbcpukqVcyFcb7lztZIdMFdKW6qGMaWcrnrVCBADaOD9MAyllY0Ch4WqFLcarXSdrE7Iq4PuLsWbBfJs_Jg7PNAGiEs2XEt0FP3WCH35F_Q6LgnNXFFCqVoLIRDFD6guxZwTDGaXRm_TreHMrDmaQ44GczRrjmblvLhTXpyH_g_jd3AIKA-AjKNwCene6v-q_gK5eqh5</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1847768444</pqid></control><display><type>article</type><title>Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Samayoa, Andres X. ; Pezzi, Todd A. ; Pezzi, Christopher M. ; Greer Gay, E. ; Asai, Megumi ; Kulkarni, Nandini ; Carp, Ned ; Chun, Stephen G. ; Putnam, Joe B.</creator><creatorcontrib>Samayoa, Andres X. ; Pezzi, Todd A. ; Pezzi, Christopher M. ; Greer Gay, E. ; Asai, Megumi ; Kulkarni, Nandini ; Carp, Ned ; Chun, Stephen G. ; Putnam, Joe B.</creatorcontrib><description>Background
The benefit of thoracic lymphadenectomy in the treatment of resectable non-small cell lung cancer (NSCLC) continues to be debated. We hypothesized that the number of lymph nodes (LNs) removed for patients with pathologic node-negative NSCLC would correlate with survival.
Methods
The National Cancer Data Base (NCDB) was queried for resected, node-negative, NSCLC patients treated between 2004 and 2014. Patients were grouped according to the number of LNs removed (1–4, 5–8, 9–12, 13–16, and ≥17). Patients with <10 LNs removed were also compared with those with ≥10 LNs removed. A Cox regression analysis was performed and hazard ratios (HRs) calculated, with 95 % confidence intervals (CIs).
Results
Of 1,089,880 patients with NSCLC reported to the NCDB during the study period, 98,970 (9.0 %) underwent resection without evidence of pathologic nodal involvement. Lobectomy was performed in 83.9 %, sublobar resection was performed in 12.7 % and pneumonectomy was performed in 2.8 % of patients. The number of LNs removed correlated with increasing tumor size and extent of resection. On multivariate analysis, increasing age, male sex, white ethnicity, high tumor grade, larger tumor size, pneumonectomy, and positive surgical margins were all negatively correlated with overall survival. The number of LNs removed and lobectomy/bi-lobectomy correlated with improved survival. The removal of <10 LNs was associated with a 12 % increased risk of death (HR: 1.12, 95 % CI 1.09–1.14;
p
< 0.001).
Conclusion
Survival of early-stage NSCLC patients is associated with the number of LNs removed. The surgical management of early-stage NSCLC should include thoracic lymphadenectomy of at least 10 nodes.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-016-5509-4</identifier><identifier>PMID: 27531307</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Aged ; Carcinoma, Non-Small-Cell Lung - ethnology ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; Carcinoma, Non-Small-Cell Lung - surgery ; Databases, Factual ; Female ; Humans ; Lung Neoplasms - ethnology ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Lung Neoplasms - surgery ; Lymph Node Excision - statistics & numerical data ; Lymph Nodes - pathology ; Lymph Nodes - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Neoplasm, Residual ; Oncology ; Pneumonectomy - statistics & numerical data ; Proportional Hazards Models ; Sex Factors ; Surgery ; Surgical Oncology ; Survival Rate ; Thoracic Oncology ; Thorax ; Tumor Burden ; United States - epidemiology</subject><ispartof>Annals of surgical oncology, 2016-12, Vol.23 (Suppl 5), p.1005-1011</ispartof><rights>Society of Surgical Oncology 2016</rights><rights>Annals of Surgical Oncology is a copyright of Springer, 2016.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-4bda1bb675ce0b25a2790077b83d794e4fe8e1dfff2a597ebff27371a8434bc53</citedby><cites>FETCH-LOGICAL-c372t-4bda1bb675ce0b25a2790077b83d794e4fe8e1dfff2a597ebff27371a8434bc53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-016-5509-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-016-5509-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27531307$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Samayoa, Andres X.</creatorcontrib><creatorcontrib>Pezzi, Todd A.</creatorcontrib><creatorcontrib>Pezzi, Christopher M.</creatorcontrib><creatorcontrib>Greer Gay, E.</creatorcontrib><creatorcontrib>Asai, Megumi</creatorcontrib><creatorcontrib>Kulkarni, Nandini</creatorcontrib><creatorcontrib>Carp, Ned</creatorcontrib><creatorcontrib>Chun, Stephen G.</creatorcontrib><creatorcontrib>Putnam, Joe B.</creatorcontrib><title>Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The benefit of thoracic lymphadenectomy in the treatment of resectable non-small cell lung cancer (NSCLC) continues to be debated. We hypothesized that the number of lymph nodes (LNs) removed for patients with pathologic node-negative NSCLC would correlate with survival.
Methods
The National Cancer Data Base (NCDB) was queried for resected, node-negative, NSCLC patients treated between 2004 and 2014. Patients were grouped according to the number of LNs removed (1–4, 5–8, 9–12, 13–16, and ≥17). Patients with <10 LNs removed were also compared with those with ≥10 LNs removed. A Cox regression analysis was performed and hazard ratios (HRs) calculated, with 95 % confidence intervals (CIs).
Results
Of 1,089,880 patients with NSCLC reported to the NCDB during the study period, 98,970 (9.0 %) underwent resection without evidence of pathologic nodal involvement. Lobectomy was performed in 83.9 %, sublobar resection was performed in 12.7 % and pneumonectomy was performed in 2.8 % of patients. The number of LNs removed correlated with increasing tumor size and extent of resection. On multivariate analysis, increasing age, male sex, white ethnicity, high tumor grade, larger tumor size, pneumonectomy, and positive surgical margins were all negatively correlated with overall survival. The number of LNs removed and lobectomy/bi-lobectomy correlated with improved survival. The removal of <10 LNs was associated with a 12 % increased risk of death (HR: 1.12, 95 % CI 1.09–1.14;
p
< 0.001).
Conclusion
Survival of early-stage NSCLC patients is associated with the number of LNs removed. The surgical management of early-stage NSCLC should include thoracic lymphadenectomy of at least 10 nodes.</description><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Non-Small-Cell Lung - ethnology</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>Carcinoma, Non-Small-Cell Lung - surgery</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Humans</subject><subject>Lung Neoplasms - ethnology</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - surgery</subject><subject>Lymph Node Excision - statistics & numerical data</subject><subject>Lymph Nodes - pathology</subject><subject>Lymph Nodes - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Staging</subject><subject>Neoplasm, Residual</subject><subject>Oncology</subject><subject>Pneumonectomy - statistics & numerical data</subject><subject>Proportional Hazards Models</subject><subject>Sex Factors</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><subject>Thoracic Oncology</subject><subject>Thorax</subject><subject>Tumor Burden</subject><subject>United States - epidemiology</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1UcFu1TAQtBCIlsIHcEGWuHBowE7s2OGGIgpIj4Je4WzZyaZNFduvdvJQP4m_ZKNXUIXgYq92Z2a1M4Q85-w1L4V8kzkTlSgYrwspWVOIB-SYS-yIWvOHWLNaF01ZyyPyJOdrxriqmHxMjkolK14xdUx-bu08xmAnoENM1NLPYxj94un54h0kGge6ufW7K3oee8h0Cz7uoac_xnltheLC22miLeCzWcIlbW3okLaFDN0q_Ja2MSWYcAtO5yu4J_wPyYsl7ce9negYaKNPG8XoV6RCmPNT8miwU4Znd_8J-X72_lv7sdh8-fCpfbcpukqVcyFcb7lztZIdMFdKW6qGMaWcrnrVCBADaOD9MAyllY0Ch4WqFLcarXSdrE7Iq4PuLsWbBfJs_Jg7PNAGiEs2XEt0FP3WCH35F_Q6LgnNXFFCqVoLIRDFD6guxZwTDGaXRm_TreHMrDmaQ44GczRrjmblvLhTXpyH_g_jd3AIKA-AjKNwCene6v-q_gK5eqh5</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Samayoa, Andres X.</creator><creator>Pezzi, Todd A.</creator><creator>Pezzi, Christopher M.</creator><creator>Greer Gay, E.</creator><creator>Asai, Megumi</creator><creator>Kulkarni, Nandini</creator><creator>Carp, Ned</creator><creator>Chun, Stephen G.</creator><creator>Putnam, Joe B.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20161201</creationdate><title>Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients</title><author>Samayoa, Andres X. ; Pezzi, Todd A. ; Pezzi, Christopher M. ; Greer Gay, E. ; Asai, Megumi ; Kulkarni, Nandini ; Carp, Ned ; Chun, Stephen G. ; Putnam, Joe B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-4bda1bb675ce0b25a2790077b83d794e4fe8e1dfff2a597ebff27371a8434bc53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Carcinoma, Non-Small-Cell Lung - ethnology</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>Carcinoma, Non-Small-Cell Lung - surgery</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Humans</topic><topic>Lung Neoplasms - ethnology</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - surgery</topic><topic>Lymph Node Excision - statistics & numerical data</topic><topic>Lymph Nodes - pathology</topic><topic>Lymph Nodes - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Staging</topic><topic>Neoplasm, Residual</topic><topic>Oncology</topic><topic>Pneumonectomy - statistics & numerical data</topic><topic>Proportional Hazards Models</topic><topic>Sex Factors</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><topic>Thoracic Oncology</topic><topic>Thorax</topic><topic>Tumor Burden</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Samayoa, Andres X.</creatorcontrib><creatorcontrib>Pezzi, Todd A.</creatorcontrib><creatorcontrib>Pezzi, Christopher M.</creatorcontrib><creatorcontrib>Greer Gay, E.</creatorcontrib><creatorcontrib>Asai, Megumi</creatorcontrib><creatorcontrib>Kulkarni, Nandini</creatorcontrib><creatorcontrib>Carp, Ned</creatorcontrib><creatorcontrib>Chun, Stephen G.</creatorcontrib><creatorcontrib>Putnam, Joe B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Samayoa, Andres X.</au><au>Pezzi, Todd A.</au><au>Pezzi, Christopher M.</au><au>Greer Gay, E.</au><au>Asai, Megumi</au><au>Kulkarni, Nandini</au><au>Carp, Ned</au><au>Chun, Stephen G.</au><au>Putnam, Joe B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>23</volume><issue>Suppl 5</issue><spage>1005</spage><epage>1011</epage><pages>1005-1011</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
The benefit of thoracic lymphadenectomy in the treatment of resectable non-small cell lung cancer (NSCLC) continues to be debated. We hypothesized that the number of lymph nodes (LNs) removed for patients with pathologic node-negative NSCLC would correlate with survival.
Methods
The National Cancer Data Base (NCDB) was queried for resected, node-negative, NSCLC patients treated between 2004 and 2014. Patients were grouped according to the number of LNs removed (1–4, 5–8, 9–12, 13–16, and ≥17). Patients with <10 LNs removed were also compared with those with ≥10 LNs removed. A Cox regression analysis was performed and hazard ratios (HRs) calculated, with 95 % confidence intervals (CIs).
Results
Of 1,089,880 patients with NSCLC reported to the NCDB during the study period, 98,970 (9.0 %) underwent resection without evidence of pathologic nodal involvement. Lobectomy was performed in 83.9 %, sublobar resection was performed in 12.7 % and pneumonectomy was performed in 2.8 % of patients. The number of LNs removed correlated with increasing tumor size and extent of resection. On multivariate analysis, increasing age, male sex, white ethnicity, high tumor grade, larger tumor size, pneumonectomy, and positive surgical margins were all negatively correlated with overall survival. The number of LNs removed and lobectomy/bi-lobectomy correlated with improved survival. The removal of <10 LNs was associated with a 12 % increased risk of death (HR: 1.12, 95 % CI 1.09–1.14;
p
< 0.001).
Conclusion
Survival of early-stage NSCLC patients is associated with the number of LNs removed. The surgical management of early-stage NSCLC should include thoracic lymphadenectomy of at least 10 nodes.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>27531307</pmid><doi>10.1245/s10434-016-5509-4</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Aged Carcinoma, Non-Small-Cell Lung - ethnology Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology Carcinoma, Non-Small-Cell Lung - surgery Databases, Factual Female Humans Lung Neoplasms - ethnology Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - surgery Lymph Node Excision - statistics & numerical data Lymph Nodes - pathology Lymph Nodes - surgery Male Medicine Medicine & Public Health Middle Aged Neoplasm Grading Neoplasm Staging Neoplasm, Residual Oncology Pneumonectomy - statistics & numerical data Proportional Hazards Models Sex Factors Surgery Surgical Oncology Survival Rate Thoracic Oncology Thorax Tumor Burden United States - epidemiology |
| title | Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients |
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