Commission on cancer standards for lymph node sampling and oncologic outcomes after lung resection Journal Article
| Authors: | Resio, B. J.; Tan, K. S.; Skovgard, M.; Dycoco, J.; Adusumilli, P. S.; Bains, M. S.; Bott, M. J.; Downey, R. J.; Gray, K. D.; Huang, J.; Molena, D.; Park, B. J.; Rusch, V. W.; Sihag, S.; Rocco, G.; Jones, D. R.; Isbell, J. M. |
| Article Title: | Commission on cancer standards for lymph node sampling and oncologic outcomes after lung resection |
| Abstract: | Background: The newest Commission on Cancer standards recommend sampling 3 mediastinal and 1 hilar lymph node stations, 3 (N2) 1 (N1), for lung cancer resections. However, the relationship between the Commission on Cancer standards and outcomes has not been thoroughly investigated. Methods: A prospective institutional database was queried for clinical stage I-III lung resections before the implementation of the new standards. The relationship between the 3 (N2) 1 (N1) standard (“guideline concordant”) and outcomes (upstaging, complications, receipt of adjuvant therapy, locoregional/distant recurrence, and survival) was assessed with multivariable models and stratified by stage. Results: Of 9289 pulmonary resections, 3048 (33%) were guideline concordant and 6241 (67%) were not. Compared with nonconcordant, those that were guideline concordant had higher rates of nodal upstaging (21% vs 13%; odds ratio [OR], 1.32 [95% CI, 1.14-1.51]; P <.001) and in-hospital complications (34% vs 27%; OR, 1.17 [95% CI, 1.05-1.30]; P =.004) but similar adjuvant systemic therapy administration (19% vs 13%; OR, 1.09 [95% CI, 0.95-1.24]; P =.2; 98% chemotherapy). Locoregional and distant recurrences were not significantly improved with guideline concordance across clinical stage I, II, and III subsets. Overall survival was similar in clinical stages I and II, but improved survival was observed for guideline concordant clinical stage III patients (hazard ratio, 0.85 [95% CI, 0.74-0.97]; P =.02). Conclusions: Sampling 3 (N2) 1 (N1) was associated with increased upstaging and complications but not with decreased recurrence or mortality in clinical stage I or II patients. Survival was improved for concordant, clinical stage III patients. Further study is indicated to determine the ideal lymph node sampling strategy across heterogeneous lung cancer patients. © 2025 The Society of Thoracic Surgeons |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; middle aged; cancer surgery; survival rate; retrospective studies; major clinical study; overall survival; mortality; cancer recurrence; systemic therapy; cancer patient; cancer staging; follow up; lymph node metastasis; antineoplastic agent; lymph node dissection; lymph nodes; lymphatic metastasis; neoplasm staging; prospective study; lymph node excision; prospective studies; cancer immunotherapy; neoplasm recurrence, local; lung lobectomy; lung neoplasms; pneumonectomy; cohort analysis; lung cancer; practice guideline; pathology; retrospective study; lung tumor; lung adenocarcinoma; tumor recurrence; adjuvant chemotherapy; lymph node; practice guidelines as topic; surgery; preoperative treatment; postoperative hemorrhage; forced expiratory volume; mediastinoscopy; video assisted thoracoscopic surgery; sampling; cumulative incidence; surgical margin; molecularly targeted therapy; clinical outcome; endobronchial ultrasonography; wedge resection; procedures; chylothorax; open surgery; recurrent laryngeal nerve injury; humans; human; male; female; article; squamous cell lung carcinoma; segmentectomy |
| Journal Title: | Annals of Thoracic Surgery |
| Volume: | 119 |
| Issue: | 2 |
| ISSN: | 0003-4975 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2025-02-01 |
| Start Page: | 308 |
| End Page: | 315 |
| Language: | English |
| DOI: | 10.1016/j.athoracsur.2024.09.009 |
| PUBMED: | 39299477 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: James M. Isbell -- Source: Scopus |
