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Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer.

Publication ,  Journal Article
Rucker, AJ; Raman, V; Jawitz, OK; Voigt, SL; Tong, BC; D'Amico, TA; Harpole, DH
Published in: The Annals of thoracic surgery
December 2020

The National Comprehensive Cancer Network guidelines recommend surgery for limited stage small cell lung cancer (SCLC). However, there is no literature on minimum acceptable lymph node retrieval in surgery for SCLC.The National Cancer Database was queried for adult patients undergoing lobectomy for limited stage (cT1-2N0M0) SCLC from 2004 to 2015. Patients with unknown survival, staging, or nodal assessment, and patients who received neoadjuvant therapy were excluded. The number of lymph nodes assessed was studied both as a continuous variable and as a categoric variable stratified into distribution quartiles. The primary outcome was overall survival and the secondary outcome was pathologic nodal upstaging.A total of 1051 patients met study criteria. In multivariable analysis, only a retrieval of eight to 12 nodes was associated with a significant survival benefit (hazard ratio 0.73; 95% confidence interval, 0.56 to 0.98). However, when modeled as a continuous variable, there was no association between number of nodes assessed and survival (hazard ratio 1.00; 95% confidence interval, 0.98 to 1.02). The overall rate of pathologic nodal upstaging was 19%. Modeled as a continuous variable, more than seven lymph nodes assessed at time of resection was significantly associated with nodal upstaging in multivariable regression (odds ratio 1.03; 95% confidence interval, 1.01 to 1.06).In this study, there was no clear difference in survival based on increasing the number of lymph nodes assessed during lobectomy for limited stage SCLC. However, the number of retrieved lymph nodes was associated with pathologic nodal upstaging. Therefore, patients may benefit from retrieval of more than seven lymph nodes during lobectomy for SCLC.

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Published In

The Annals of thoracic surgery

DOI

EISSN

1552-6259

ISSN

0003-4975

Publication Date

December 2020

Volume

110

Issue

6

Start / End Page

1854 / 1860

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Small Cell Lung Carcinoma
  • Retrospective Studies
  • Respiratory System
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lymph Nodes
 

Citation

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Rucker, A. J., Raman, V., Jawitz, O. K., Voigt, S. L., Tong, B. C., D’Amico, T. A., & Harpole, D. H. (2020). Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer. The Annals of Thoracic Surgery, 110(6), 1854–1860. https://doi.org/10.1016/j.athoracsur.2020.04.117
Rucker, A Justin, Vignesh Raman, Oliver K. Jawitz, Soraya L. Voigt, Betty C. Tong, Thomas A. D’Amico, and David H. Harpole. “Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer.The Annals of Thoracic Surgery 110, no. 6 (December 2020): 1854–60. https://doi.org/10.1016/j.athoracsur.2020.04.117.
Rucker AJ, Raman V, Jawitz OK, Voigt SL, Tong BC, D’Amico TA, et al. Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer. The Annals of thoracic surgery. 2020 Dec;110(6):1854–60.
Rucker, A. Justin, et al. “Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer.The Annals of Thoracic Surgery, vol. 110, no. 6, Dec. 2020, pp. 1854–60. Epmc, doi:10.1016/j.athoracsur.2020.04.117.
Rucker AJ, Raman V, Jawitz OK, Voigt SL, Tong BC, D’Amico TA, Harpole DH. Effect of Lymph Node Assessment on Outcomes in Surgery for Limited Stage Small Cell Lung Cancer. The Annals of thoracic surgery. 2020 Dec;110(6):1854–1860.
Journal cover image

Published In

The Annals of thoracic surgery

DOI

EISSN

1552-6259

ISSN

0003-4975

Publication Date

December 2020

Volume

110

Issue

6

Start / End Page

1854 / 1860

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Small Cell Lung Carcinoma
  • Retrospective Studies
  • Respiratory System
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lymph Nodes