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A large real-world cohort study of examined lymph node standards for adequate nodal staging in early non-small cell lung cancer

BACKGROUND: The current National Comprehensive Cancer Network (NCCN) guidelines for non-small cell lung cancer (NSCLC) recommend that surgeons sample is not clear. We aimed to define a minimal number of examined lymph nodes for removal or sampling for optimized nodal staging recommendation, with a f...

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Detalles Bibliográficos
Autores principales: Zhu, Zhihua, Song, Zhengbo, Jiao, Wenjie, Mei, Weijian, Xu, Chunwei, Huang, Qinghua, An, Chaolun, Shi, Jianguang, Wang, Wenxian, Yu, Guiping, Sun, Pingli, Zhang, Yinbin, Shen, Jianfei, Song, Yong, Qian, Jun, Yao, Wang, Yang, Han
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947406/
https://www.ncbi.nlm.nih.gov/pubmed/33718024
http://dx.doi.org/10.21037/tlcr-20-1024
Descripción
Sumario:BACKGROUND: The current National Comprehensive Cancer Network (NCCN) guidelines for non-small cell lung cancer (NSCLC) recommend that surgeons sample is not clear. We aimed to define a minimal number of examined lymph nodes for removal or sampling for optimized nodal staging recommendation, with a focus on T(1–3)N(0)M(0) patients. METHODS: A total of 55,101 consecutive patients were selected, including 52,099 patients with US Surveillance, Epidemiology, and End Results (SEER) data and 3,002 patients in a Chinese multicenter database from 11 thoracic referral centers, who underwent complete resection plus lymph node dissection or sampling for stage T(1–3)N(0)M(0) NSCLC. Propensity score-matching analysis was performed with R software, and a cut-off value was calculated using X-tile software. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard models. RESULTS: Five-year survival rates with respect to total examined lymph nodes numbers (examined lymph nodes <10 vs. examined lymph nodes ≥10) were 69% and 64% (group A), 66% and 63% (group B), 62% and 58% (group C), 81% and 75% (group D). There were significant differences between examined lymph nodes <10 and examined lymph nodes >10 in each group (P<0.001). CONCLUSIONS: A minimum of 10 examined lymph nodes would significantly improve T(1–3)N(0)M(0) NSCLC prognosis and patients’ survival rates if implemented as a minimum standard for lymphadenectomy. Therefore, we recommended a minimum of 10 examined lymph nodes for T(1–3)N(0)M(0) patients.