Mediastinal Lymph Node Dissection Affects Survival in Patients with Stage I Non-Small Cell Lung Cancer

Abstract

Background: The therapeutic value of mediastinal lymph node dissection (LND) for early-stage non-small cell lung cancer (NSCLC) remains controversial. We conducted a retrospective study to investigate the impact of mediastinal LND on survival in patients with stage I NSCLC. Methods: Clinical data of patients with stage I NSCLC who were treated with surgical resection during a period of ten years were reviewed. The patients were categorized into lobectomy (or pneumonectomy) combined with mediastinal LND or lymph node sampling (LNS) according to the record of their operative procedures. The Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for multivariate analysis. Results: Of the 319 patients who were included in the study, 139 patients received mediastinal LND, while 180 underwent LNS. There was a significant difference in overall survival (OS) between the group with LND and the group with LNS (5-year survival rate: 76.4 % vs. 65.9 %, p = 0.015 by log rank test). Multivariate analysis showed that lymph node dissection (RR = 0.548, 95 %CI: 0.350 - 0.858, p = 0.009), together with the stage, significantly influenced overall survival. Conclusions: Lobectomy combined with mediastinal LND can improve survival in patients with stage I NSCLC. It should be performed in all patients with clinical stage I NSCLC.

Key words

thoracic surgery - non‐small cell lung cancer - mediastinal lymph node dissection

References

• 1 Izbicki J R, Passlick B, Pantel K. et al . Effectiveness of radical systematic mediastinal lymphadenectomy in patients with respectable non-small cell lung cancer.  Ann Surg. 1998;  227 (1) 138-144
• 2 Wertzel H, Siebert H, Lange W, Swoboda L, Graf E, Hasse J. Results after surgery in stage-I bronchogenic carcinoma.  Thorac Cardiovasc Surg. 1998;  46 365-369
• 3 Doddoli C, Aragon A, Barlesi F. et al . Does the extent of lymph node dissection influence outcome in patients with stage I non-small cell lung cancer?.  Eur J Cardiothorac Surg. 2005;  27 680-685
• 4 Gajra A, Newman N, Gamble G P, Kohman L J, Graziano S L. Effect of lymph nodes sampled on outcome in patients with stage I non-small cell lung cancer.  J Clin Oncol. 2003;  21 1029-1034
• 5 Ludwig M S, Goodman M, Miller D L, Johnstone P AS. Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer.  Chest. 2005;  128 1545-1550
• 6 Wu Y L, Huang Z H, Wang S Y, Yang X N, Ou W. A randomized trial of systemic nodal dissection in resectable non-small cell lung cancer.  Lung Cancer. 2002;  36 1-6
• 7 Okada M, Sakamoto T, Yuki T, Mimura T, Miyoshi K, Tsubota N. Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer.  Ann Thorac Surg. 2006;  81 1028-1033
• 8 Yoshimasu T, Miyoshi S, Oura S, Hirai I, Kokawa Y, Okamura Y. Limited mediastinal lymph node dissection for non-small cell lung cancer according to intraoperative histologic examinations.  J Thorac Cardiovasc Surg. 2005;  130 433-437
• 9 Mountain C F. Revisions in the international system for staging lung cancer.  Chest. 1997;  111 (6) 1710-1717
• 10 Mountain C F, Dresler C M. Regional lymph node classification for lung cancer staging.  Chest. 1997;  111 (6) 1718-1723
• 11 Feinstein A R, Sosin D M, Wells C K. The Will Rogers phenomenon, stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer.  N Engl J Med. 1985;  312 1604-1608
• 12 Wu J, Ohta Y, Minato H. et al . Nodal occult metastasis in patients with peripheral lung adenocarcinoma of 2.0 cm or less in diameter.  Ann Thorac Surg. 2001;  71 1772-1778
• 13 Gu C D, Osaki T, Oyama T. et al . Detection of micrometastatic tumor cells in pN0 lymph nodes of patients with completely resected non-small cell lung cancer.  Ann Surg. 2002;  235 (1) 133-139
• 14 Goldstraw P. Report on the international workshop on intrathoracic staging, London, October 1996.  Lung Cancer. 1997;  18 107-111
• 15 Takizawa T, Terashima M, Koike T, Akamatsu H, Kurita Y, Yokoyama A. Mediastinal lymph node metastasis in patients with clinical stage I peripheral non small cell lung cancer.  J Thorac Cardiovasc Surg. 1997;  113 (2) 248-252
• 16 Shankar L K, Sullivan D C. Functional imaging in lung cancer.  J Clin Oncol. 2005;  23 3203-3211
• 17 Kelly R F, Tran T, Holmstrom A. et al . Accuracy and cost-effectiveness of PET scan in potentially resectable non small cell lung cancer.  Chest. 2004;  123 1413-1423
• 18 Allen M S, Darling G E, Pechet T. et al . Morbidity and mortality of major pulmonary resections in patients with early stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial.  Ann Thorac Surg. 2006;  81 1013-1020