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Mediastinal lymph node dissection for the elderly with clinical stage I non-small cell lung cancer

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Abstract

Objectives

We aimed to compare the differences in prognosis and perioperative complications between patients with and without mediastinal lymph node dissection (MLND) among elderly patients with clinical stage I non-small cell lung cancer (NSCLC).

Methods

We analysed 439 patients ≥ 75 years of age with NSCLC classified as clinical stage I who underwent complete resection with lobectomy. We divided the patients into two groups. Those with MLND were included in the MLND group (n = 365), and those without MLND or adequate systematic mediastinal lymph node sampling were included in the non-MLND group (n = 74). To reduce selection bias, a propensity score matching method (3:1) was implemented. We compared survival and the incidence of perioperative complications.

Results

After matching, we compared 171 patients in the MLND group to 57 patients in the non-MLND group. There were no significant differences in clinicopathological characteristics between the groups. The non-MLND group did not show a significantly better prognosis than the MLND group in overall survival and cancer-specific survival (p = 0.246 and 0.150, respectively). The cumulative incidence of recurrence was similar in the two groups. MLND did not affect chest drain duration or hospitalization. The numbers of patients with perioperative complications ≥ grade 2 or ≥ grade 3 did not differ between the groups (p = 0.312 and > 0.999, respectively).

Conclusions

Anatomical pulmonary resection without MLND might be a treatment option for elderly patients with clinical stage I NSCLC. Further investigation is needed to clarify the value of MLND, especially for vulnerable elderly individuals.

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Authors and Affiliations

  1. Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Shinya Katsumata, Kenta Tane, Jun Suzuki, Tomohiro Miyoshi, Joji Samejima, Keiju Aokage & Masahiro Tsuboi

  2. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Japan

    Genichiro Ishii

Authors
  1. Shinya Katsumata
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  2. Kenta Tane
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  3. Jun Suzuki
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  4. Tomohiro Miyoshi
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  5. Joji Samejima
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  6. Keiju Aokage
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  7. Genichiro Ishii
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  8. Masahiro Tsuboi
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Correspondence to Kenta Tane.

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Supplementary file5 Supplemental Fig. 1: Patient flow (PPTX 38 KB)

11748_2021_1656_MOESM6_ESM.pptx

Supplementary file6 Supplemental Fig. 2: Cancer-specific survival curves of patients with and without MLND. There was no significant difference in CSS (p = 0.150) between the MLND and non-MLND groups. (PPTX 53 KB)

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Katsumata, S., Tane, K., Suzuki, J. et al. Mediastinal lymph node dissection for the elderly with clinical stage I non-small cell lung cancer. Gen Thorac Cardiovasc Surg 69, 1560–1566 (2021). https://doi.org/10.1007/s11748-021-01656-8

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  • DOI: https://doi.org/10.1007/s11748-021-01656-8

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