Impact of Different Types of Lymphadenectomy Combined With Different Extents of Tumor Resection on Survival Outcomes of Stage I Non-small-cell Lung Cancer: A Large-Cohort Real-World Study.

Weidong Wang,Xuewen Zhang,Yinsheng Wen,Rusi Zhang,Kexing Xi,Lanjun Zhang,Gongming Wang,Yongqiang Chen,Dongni Chen,Xiangyang Yu,Zirui Huang

doi:10.3389/fonc.2019.00642

Abstract

Background: To investigate the prognostic impact of different types of lymphadenectomy with different extents of tumor resection on the outcomes of stage I non-small-cell lung cancer (NSCLC).Methods: Patients were classified into lobectomy and sublobectomy groups, and then each group was subdivided according to the types of lymphadenectomy. The end points of the study were overall survival (OS) and disease-free survival (DFS). Propensity score matched (PSM) comparative analysis and univariate and multivariate Cox regression analyses were performed.Result: A total of 1,336 patients were included in the current study. Lobectomy was associated with better OS and DFS. In the lobectomy group, lobectomy with bilateral mediastinal lymphadenectomy (BML) was associated with better OS than lobectomy with systematic nodal dissection (SND) or lobe-specific systematic node dissection (L-SND). Lobectomy with SND or L-SND was associated with better OS than lobectomy with systematic nodal sampling (SNS) or selected lymph node biopsy (SLNB). Additionally, lobectomy with BML or SND was associated with better DFS than lobectomy with L-SND or SNS or SLNB. After PSM, compared with lobectomy with SNS or SLNB, lobectomy with SND resulted in more favorable OS and DFS. There was no survival difference between different types of lymphadenectomy for patients who underwent sublobectomy. A multivariable analysis revealed independent associations of lobectomy with BML or SND with better OS and DFS compared with those of lobectomy with SNS or SLNB.Conclusion: This study reveals an association of lobectomy with more systematic and complete lymph node dissection, such as BML or SND, with better prognosis in stage I NSCLC patients.

Highlights

Non-small-cell lung cancer (NSCLC) is the malignancy with the highest morbidity and mortality rates worldwide [1]
When the clinicopathologic characteristics were compared among groups, it was interesting to note that sex, histology, cell differentiation, smoking history, adjuvant therapy, and treatment after disease progression were well-balanced between the subgroups in both Group Lobe and Group Sublobe
The baseline characteristics of the patients in Group Lobe are summarized in Table 2, and those in Group Sublobe are summarized in Supplemental Table 1

Summary

Introduction

Non-small-cell lung cancer (NSCLC) is the malignancy with the highest morbidity and mortality rates worldwide [1]. For surgically resectable lung cancer, surgery is the best therapeutic option. Lymph node (LN) dissection during surgery is essential. For these reasons, determining the appropriate model of resection of original tumors and LN dissection has attracted more attention. Lobectomy with SND is considered to be a standard therapy for patients with NSCLC, but for some early-stage patients, sublobectomy or SNS is acceptable [4]. To investigate the prognostic impact of different types of lymphadenectomy with different extents of tumor resection on the outcomes of stage I non-small-cell lung cancer (NSCLC)

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Discussion

Conclusion