Lobe-specific lymph node sampling is associated with lower risk of cancer recurrence.

Autor:	Subramanian MP; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Eaton DB Jr; Veterans Affairs St Louis Health Care System, St Louis, Mo., Heiden BT; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Brandt WS; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Labilles UL; Veterans Affairs St Louis Health Care System, St Louis, Mo., Chang SH; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Yan Y; Veterans Affairs St Louis Health Care System, St Louis, Mo.; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Schoen MW; Division 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, Mo., Patel MR; Veterans Affairs St Louis Health Care System, St Louis, Mo., Kreisel D; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Nava RG; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Thomas T; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo., Meyers BF; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Kozower BD; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo., Puri V; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
Jazyk:	angličtina
Zdroj:	JTCVS open [JTCVS Open] 2023 Nov 23; Vol. 17, pp. 271-283. Date of Electronic Publication: 2023 Nov 23 (Print Publication: 2024).
DOI:	10.1016/j.xjon.2023.11.009
Abstrakt:	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. Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (© 2024 The Authors.)
Databáze:	MEDLINE
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