Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspective
Objective: Adequate intraoperative lymph node (LN) assessment is a critical component of early-stage non–small cell lung cancer (NSCLC) resection. The National Comprehensive Cancer Network and the American College of Surgeons Commission on Cancer (CoC) recommend station-based sampling minimums agnos...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-02-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623003649 |
| _version_ | 1827347885576945664 |
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| author | Melanie P. Subramanian, MD, MPHS Daniel B. Eaton, Jr., MPH Brendan T. Heiden, MD, MPHS Whitney S. Brandt, MD Ulysses L. Labilles, PhD Su-Hsin Chang, PhD, SM Yan Yan, MD, PhD Martin W. Schoen, MD, MPHS Mayank R. Patel, MD Daniel Kreisel, MD, PhD Ruben G. Nava, MD Theodore Thomas, MD, MPH Bryan F. Meyers, MD, MPH Benjamin D. Kozower, MD, MPHS Varun Puri, MD, MSCI |
| author_facet | Melanie P. Subramanian, MD, MPHS Daniel B. Eaton, Jr., MPH Brendan T. Heiden, MD, MPHS Whitney S. Brandt, MD Ulysses L. Labilles, PhD Su-Hsin Chang, PhD, SM Yan Yan, MD, PhD Martin W. Schoen, MD, MPHS Mayank R. Patel, MD Daniel Kreisel, MD, PhD Ruben G. Nava, MD Theodore Thomas, MD, MPH Bryan F. Meyers, MD, MPH Benjamin D. Kozower, MD, MPHS Varun Puri, MD, MSCI |
| author_sort | Melanie P. Subramanian, MD, MPHS |
| collection | DOAJ |
| description | Objective: Adequate intraoperative lymph node (LN) assessment is a critical component of early-stage non–small cell lung cancer (NSCLC) resection. The National Comprehensive Cancer Network and the American College of Surgeons Commission on Cancer (CoC) recommend station-based sampling minimums agnostic to tumor location. Other institutions advocate for lobe-specific LN sampling strategies that consider the anatomic likelihood of LN metastases. We examined the relationship between lobe-specific LN assessment and long-term outcomes using a robust, highly curated cohort of stage I NSCLC patients. Methods: We performed a cohort study using a uniquely compiled dataset from the Veterans Health Administration and manually abstracted data from operative and pathology reports for patients with clinical stage I NSCLC (2006-2016). For simplicity in comparison, we included patients who had right upper lobe (RUL) or left upper lobe (LUL) tumors. Based on modified European Society of Thoracic Surgeons guidelines, lobe-specific sampling was defined for RUL tumors (stations 2, 4, 7, and 10 or 11) and LUL tumors (stations 5 or 6, 7, and 10 or 11). Our primary outcome was the risk of cancer recurrence, as assessed by Fine and Gray competing risks modeling. Secondary outcomes included overall survival (OS) and pathologic upstaging. Analyses were adjusted for relevant patient, disease, and treatment variables. Results: Our study included 3534 patients with RUL tumors and 2667 patients with LUL tumors. Of these, 277 patients (7.8%) with RUL tumors and 621 patients (23.2%) with LUL tumors met lobe-specific assessment criteria. Comparatively, 34.7% of patients met the criteria for count-based assessment, and 25.8% met the criteria for station-based sampling (ie, any 3 N2 stations and 1 N1 station). Adherence to lobe-specific assessment was associated with lower cumulative incidence of recurrence (adjusted hazard ratio [aHR], 0.83; 95% confidence interval [CI], 0.70-0.98) and a higher likelihood of pathologic upstaging (aHR, 1.49; 95% CI, 1.20-1.86). Lobe-specific assessment was not associated with OS. Conclusions: Adherence to intraoperative LN sampling guidelines is low. Lobe-specific assessment is associated with superior outcomes in early-stage NSCLC. Quality metrics that assess adherence to intraoperative LN sampling, such as the CoC Operative Standards manual, also should consider lobe-specific criteria. |
| first_indexed | 2024-03-07T23:59:28Z |
| format | Article |
| id | doaj.art-11351de7a6cf4251b73d35ecb304709c |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-07T23:59:28Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-11351de7a6cf4251b73d35ecb304709c2024-02-18T04:43:55ZengElsevierJTCVS Open2666-27362024-02-0117271283Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspectiveMelanie P. Subramanian, MD, MPHS0Daniel B. Eaton, Jr., MPH1Brendan T. Heiden, MD, MPHS2Whitney S. Brandt, MD3Ulysses L. Labilles, PhD4Su-Hsin Chang, PhD, SM5Yan Yan, MD, PhD6Martin W. Schoen, MD, MPHS7Mayank R. Patel, MD8Daniel Kreisel, MD, PhD9Ruben G. Nava, MD10Theodore Thomas, MD, MPH11Bryan F. Meyers, MD, MPH12Benjamin D. Kozower, MD, MPHS13Varun Puri, MD, MSCI14Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo; Address for reprints: Melanie P. Subramanian, MD, MPHS, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8234, St Louis, MO 63110.Veterans Affairs St Louis Health Care System, St Louis, MoDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MoDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MoVeterans Affairs St Louis Health Care System, St Louis, MoDivision of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MoVeterans Affairs St Louis Health Care System, St Louis, Mo; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MoDivision of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, MoVeterans Affairs St Louis Health Care System, St Louis, MoDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MoDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MoDivision of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, MoDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MoDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MoDivision of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MoObjective: Adequate intraoperative lymph node (LN) assessment is a critical component of early-stage non–small cell lung cancer (NSCLC) resection. The National Comprehensive Cancer Network and the American College of Surgeons Commission on Cancer (CoC) recommend station-based sampling minimums agnostic to tumor location. Other institutions advocate for lobe-specific LN sampling strategies that consider the anatomic likelihood of LN metastases. We examined the relationship between lobe-specific LN assessment and long-term outcomes using a robust, highly curated cohort of stage I NSCLC patients. Methods: We performed a cohort study using a uniquely compiled dataset from the Veterans Health Administration and manually abstracted data from operative and pathology reports for patients with clinical stage I NSCLC (2006-2016). For simplicity in comparison, we included patients who had right upper lobe (RUL) or left upper lobe (LUL) tumors. Based on modified European Society of Thoracic Surgeons guidelines, lobe-specific sampling was defined for RUL tumors (stations 2, 4, 7, and 10 or 11) and LUL tumors (stations 5 or 6, 7, and 10 or 11). Our primary outcome was the risk of cancer recurrence, as assessed by Fine and Gray competing risks modeling. Secondary outcomes included overall survival (OS) and pathologic upstaging. Analyses were adjusted for relevant patient, disease, and treatment variables. Results: Our study included 3534 patients with RUL tumors and 2667 patients with LUL tumors. Of these, 277 patients (7.8%) with RUL tumors and 621 patients (23.2%) with LUL tumors met lobe-specific assessment criteria. Comparatively, 34.7% of patients met the criteria for count-based assessment, and 25.8% met the criteria for station-based sampling (ie, any 3 N2 stations and 1 N1 station). Adherence to lobe-specific assessment was associated with lower cumulative incidence of recurrence (adjusted hazard ratio [aHR], 0.83; 95% confidence interval [CI], 0.70-0.98) and a higher likelihood of pathologic upstaging (aHR, 1.49; 95% CI, 1.20-1.86). Lobe-specific assessment was not associated with OS. Conclusions: Adherence to intraoperative LN sampling guidelines is low. Lobe-specific assessment is associated with superior outcomes in early-stage NSCLC. Quality metrics that assess adherence to intraoperative LN sampling, such as the CoC Operative Standards manual, also should consider lobe-specific criteria.http://www.sciencedirect.com/science/article/pii/S2666273623003649lymph nodesurvivalrecurrencelung cancer |
| spellingShingle | Melanie P. Subramanian, MD, MPHS Daniel B. Eaton, Jr., MPH Brendan T. Heiden, MD, MPHS Whitney S. Brandt, MD Ulysses L. Labilles, PhD Su-Hsin Chang, PhD, SM Yan Yan, MD, PhD Martin W. Schoen, MD, MPHS Mayank R. Patel, MD Daniel Kreisel, MD, PhD Ruben G. Nava, MD Theodore Thomas, MD, MPH Bryan F. Meyers, MD, MPH Benjamin D. Kozower, MD, MPHS Varun Puri, MD, MSCI Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspective JTCVS Open lymph node survival recurrence lung cancer |
| title | Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspective |
| title_full | Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspective |
| title_fullStr | Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspective |
| title_full_unstemmed | Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspective |
| title_short | Lobe-specific lymph node sampling is associated with lower risk of cancer recurrenceCentral MessagePerspective |
| title_sort | lobe specific lymph node sampling is associated with lower risk of cancer recurrencecentral messageperspective |
| topic | lymph node survival recurrence lung cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623003649 |
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