Impact of the Extent of Lymph Node Dissection on Precise Staging and Survival in Clinical I–II Pure-Solid Lung Cancer Undergoing Lobectomy

Authors: Donglai Chen MD 1 , Yiming Mao MD, PhD 2 , Junmiao Wen MD 3 , 4 , Jian Shu MD 5 , 6 , Fei Ye MD 5 , 7 , Yunlang She MD 1 , Qifeng Ding MD 5 , Li Shi MD 5 , Tao Xue MD, PhD 8 , Min Fan MD, PhD 3 , 4 , Yongbing Chen MD, PhD 5 and Chang Chen MD, PhD 1
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  • 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai;
  • 2 Department of Thoracic Surgery, Suzhou Kowloon Hospital Shanghai Jiaotong University School of Medicine, Suzhou;
  • 3 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai;
  • 4 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai;
  • 5 Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou;
  • 6 Department of Thoracic Surgery, Taicang Affiliated Hospital of Soochow University, the First People’s Hospital of Taicang, Taicang;
  • 7 Department of Thoracic Surgery, Hai’an Hospital Affiliated to Nantong University, Hai’an; and
  • 8 Department of Cardiothoracic Surgery, Zhongda Hospital Southeast University, Nanjing, China.
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Background: This study sought to determine the optimal number of examined lymph nodes (ELNs) and examined node stations (ENSs) in patients with radiologically pure-solid non–small cell lung cancer (NSCLC) who underwent lobectomy and ipsilateral lymphadenectomy by investigating the impact of ELNs and ENSs on accurate staging and long-term survival. Materials and Methods: Data from 6 institutions in China on resected clinical stage I–II (cI–II) NSCLCs presenting as pure-solid tumors were analyzed for the impact of ELNs and ENSs on nodal upstaging, stage migration, recurrence-free survival (RFS), and overall survival (OS). Correlations between different endpoints and ELNs or ENSs were fitted with a LOWESS smoother, and the structural break points were determined by Chow test. Results: Both ELNs and ENSs were identified as independent prognostic factors for OS (ENS hazard ratio [HR], 0.690; 95% CI, 0.597–0.797; P<.001; ELN HR, 0.950; 95% CI, 0.917–0.983; P=.004) and RFS (ENS HR, 0.859; 95% CI, 0.793–0.931; P<.001; ELN HR, 0.960; 95% CI, 0.942–0.962; P<.001), which were also associated with postoperative nodal upstaging (ENS odds ratio [OR], 1.057; 95% CI, 1.002–1.187; P=.004; ELN OR, 1.186; 95% CI, 1.148–1.226; P<.001). A greater number of ELNs and ENSs correlated with a higher accuracy of nodal staging and a lower probability of stage migration. Cut-point analysis revealed an optimal cutoff of 18 LNs and 6 node stations for stage cI–II pure-solid NSCLCs, which were validated in our multi-institutional cohort. Conclusions: Extensive examination of LNs and node stations seemed crucial to predicting accurate staging and survival outcomes. A threshold of 18 LNs and 6 node stations might be considered for evaluating the quality of LN examination in patients with stage cI–II radiologically pure-solid NSCLCs.

Submitted February 12, 2020; accepted for publication August 6, 2020. Published online January 28, 2021.

Author contributions: Study concept and design: D. Chen, Mao, Wen, Xue, Fan, Y. Chen, C. Chen. Data acquisition: Shu, Ye, She, Ding, Shi, Xue. Data analysis and interpretation: D. Chen, Mao, Wen. Manuscript preparation: D. Chen, Mao, Wen, Shu, Ye, She, Ding, Shi. Critical revision: Xue, Fan, Y. Chen, C. Chen. Supervision: Fan, Y. Chen, C. Chen.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by projects from the Shanghai Hospital Development Center (SHDC12015116); the National Natural Science Foundation of China (81802256); the Science and Technology Commission of Shanghai Municipality (15411968400 and 14411962600); the Suzhou Key Laboratory of Thoracic Oncology (SZS201907); the Suzhou Key Discipline for Medicine (SZXK201803); the Municipal Program of People’s Livelihood Science and Technology in Suzhou (SS2019061); Jiangsu Key Research and Development Plan (Social Development) Project (BE2020653); and Clinical Research Plan of Shanghai Hospital Development Center (SHDC2020CR3025B).

Correspondence: Chang Chen, MD, PhD, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Road, Yangpu District, Shanghai 200433, China. Email: chenthoracic@163.com;Yongbing Chen, MD, PhD, Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou 215004, China. Email: chentongt@sina.com; and Min Fan, MD, PhD, Department of Radiation Oncology, Shanghai Cancer Center, Fudan University Shanghai Medical School, 270 Dong’an Road, and Department of Oncology, Shanghai Medical College, 131 Dong’an Road, Fudan University, Shanghai 200032. Email: minfan20141212@hotmail.com

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