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Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The benefit of thoracic lymphadenectomy in the treatment of resectable non-small cell lung cancer (NSCLC) continues to be debated. We hypothesized that the number of lymph nodes (LNs) removed for patients with pathologic node-negative NSCLC would correlate with survival.

Methods

The National Cancer Data Base (NCDB) was queried for resected, node-negative, NSCLC patients treated between 2004 and 2014. Patients were grouped according to the number of LNs removed (1–4, 5–8, 9–12, 13–16, and ≥17). Patients with <10 LNs removed were also compared with those with ≥10 LNs removed. A Cox regression analysis was performed and hazard ratios (HRs) calculated, with 95 % confidence intervals (CIs).

Results

Of 1,089,880 patients with NSCLC reported to the NCDB during the study period, 98,970 (9.0 %) underwent resection without evidence of pathologic nodal involvement. Lobectomy was performed in 83.9 %, sublobar resection was performed in 12.7 % and pneumonectomy was performed in 2.8 % of patients. The number of LNs removed correlated with increasing tumor size and extent of resection. On multivariate analysis, increasing age, male sex, white ethnicity, high tumor grade, larger tumor size, pneumonectomy, and positive surgical margins were all negatively correlated with overall survival. The number of LNs removed and lobectomy/bi-lobectomy correlated with improved survival. The removal of <10 LNs was associated with a 12 % increased risk of death (HR: 1.12, 95 % CI 1.09–1.14; p < 0.001).

Conclusion

Survival of early-stage NSCLC patients is associated with the number of LNs removed. The surgical management of early-stage NSCLC should include thoracic lymphadenectomy of at least 10 nodes.

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Funding

The authors have no sources of funding to disclose.

Disclosures

Andres X. Samayoa, Todd A. Pezzi, Christopher M. Pezzi, E. Greer Gay, Megumi Asai, Nandini Kulkarni, Ned Carp, Stephen G. Chun, and Joe B. Putnam Jr have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, Abington Hospital–Jefferson Health, Abington, PA, USA

    Andres X. Samayoa MD, Christopher M. Pezzi MD, Megumi Asai MD & Nandini Kulkarni MD

  2. Baylor College of Medicine, Houston, TX, USA

    Todd A. Pezzi BS

  3. American College of Surgeons, Commission on Cancer, Chicago, IL, USA

    E. Greer Gay PhD

  4. Division of Surgical Oncology, Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA

    Ned Carp MD

  5. Department of Radiation Oncology, University of Texas, MD Anderson Comprehensive Cancer Center, Houston, TX, USA

    Stephen G. Chun MD

  6. Department of Thoracic Surgery, Baptist MD Anderson Cancer Center, Jacksonville, FL, USA

    Joe B. Putnam Jr. MD

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  1. Andres X. Samayoa MD
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Correspondence to Christopher M. Pezzi MD.

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Samayoa, A.X., Pezzi, T.A., Pezzi, C.M. et al. Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients. Ann Surg Oncol 23 (Suppl 5), 1005–1011 (2016). https://doi.org/10.1245/s10434-016-5509-4

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  • DOI: https://doi.org/10.1245/s10434-016-5509-4

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