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Lymph node dissections and survival in sublobar resection of non-small cell lung cancer ≤ 20 mm

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Abstract

Background

A randomized trial of lobectomy versus segmentectomy for small-sized (≤ 20 mm) non-small cell lung cancer (NSCLC) showed that patients who had undergone segmentectomy had a significantly longer overall survival (OS) than those who had lobectomy. More attention is needed regarding the required extent of thoracic lymphadenectomy in patients with small-sized NSCLC who undergo sublobar resection.

Methods

The National Cancer Database was queried for patients with clinically node-negative NSCLC ≤ 20 mm who had undergone sublobar resection between 2004 and 2017. OS of NSCLC patients by the number of lymph node dissections (LNDs) was analyzed using log-rank tests and Cox proportional hazards model. The cutoff value of the LNDs was set to 10 according to the Commission on Cancer’s recommendation.

Results

This study included 4379 segmentectomy and 23,138 wedge resection cases. The sequential improvement in the HRs by the number of LNDs was evident, and the HR was the lowest if the number of LNDs exceeded 10. Patients with ≤ 9 LNDs had a significantly shorter OS than those with ≥ 10 LNDs (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.40–1.61, P < 0.0001). Multivariable analysis revealed that performing ≤ 9 LNDs was an independent factor for predicting OS (HR for death: 1.34, 95% CI 1.24–1.44, P < 0.0001). These results remained significant in subgroup analyses by the type of sublobar resection (segmentectomy, wedge resection).

Conclusions

Performing ≥ 10 LNDs has a prognostic role in patients with small-sized NSCLC even if the resection is sublobar.

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Acknowledgements

We thank Mindy Flannagan for statistical assistance.

Funding

There are no sources of funding to report.

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Authors and Affiliations

  1. Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, Japan

    Shinkichi Takamori

  2. Division of Hematology Oncology, University at Buffalo, 100 High St, Suite D2-76, NY, 14260, Buffalo, USA

    Takefumi Komiya

  3. Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan

    Mototsugu Shimokawa

  4. Mirro Center for Research and Innovation, Parkview Research Center, 3948- A New Vision Drive, Fort Wayne, IN, 46845, USA

    Emily Powell

  5. Oncology Research Program, Parkview Cancer Institute, 11050 Parkview Circle, Fort Wayne, IN, 46845, USA

    Emily Powell

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  1. Shinkichi Takamori
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  4. Emily Powell
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Corresponding author

Correspondence to Takefumi Komiya.

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Conflict of interest

Takefumi Komiya received travel fee from Merck and honoraria from Boehringer Ingelheim. All the authors declare no conflicts of interest in association with this study.

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11748_2022_1876_MOESM1_ESM.tiff

Supplementary file1 Supplemental Fig. 1. Study flow diagram of case eligibility. NSCLC, non-small cell lung cancer; NCDB, National Cancer Database. (TIFF 30956 KB)

Supplementary file2 (DOCX 53 KB)

Supplementary file3 (DOCX 54 KB)

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Takamori, S., Komiya, T., Shimokawa, M. et al. Lymph node dissections and survival in sublobar resection of non-small cell lung cancer ≤ 20 mm. Gen Thorac Cardiovasc Surg 71, 189–197 (2023). https://doi.org/10.1007/s11748-022-01876-6

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  • DOI: https://doi.org/10.1007/s11748-022-01876-6

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