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Abstract
Visceral pleural invasion (VPI) has been identified as an adverse prognostic factor for non‐small cell lung cancer (NSCLC). Accurate nodal staging for NSCLC correlates with improved survival, but it is unclear whether tumors with VPI require a more extensive lymph nodes (LNs) dissection to optimize survival. We aimed to evaluate the impact of VPI status on the optimal extent of LNs dissection in stage I NSCLC, using the Surveillance, Epidemiology, and End Results (SEER) database. We identified 9297 surgically treated T1‐2aN0M0 NSCLC patients with at least one examined LNs. Propensity score matching was conducted to balance the baseline clinicopathologic characteristics between the VPI group and non‐VPI group. Log‐rank tests along with Cox proportional hazards regression methods were performed to evaluate the impact of extent of LNs dissection on survival. VPI was correlated with a significant worse survival, but there was no significant difference in survival rate between PL1 and PL2. Patients who underwent sublobectomy had slightly decreased survival than those who underwent lobectomy. Pathologic LNs examination was significantly correlated with survival. Examination of 7‐8 LNs and 14‐16 LNs conferred the lowest hazard ratio for T1‐sized/non‐VPI tumors (stage IA) and T1‐sized/VPI tumors (stage IB), respectively. The optimal extent of LNs dissection varied by VPI status, with T1‐sized/VPI tumors (stage IB) requiring a more extensive LNs dissection than T1‐sized/non‐VPI tumors (stage IA). These results might provide guidelines for surgical procedure in early stage NSCLC.
Highlights
Lung cancer has been identified as the leading cause of cancer death for decades with a high incidence worldwide.[1]Approximately 85% of lung cancer patients are diagnosed with non‐small cell lung cancer (NSCLC)
Visceral pleural invasion (VPI) was determined as a negative prognosticator in NSCLC and was first incorporated into the fifth edition tumor, node, metastasis (TNM) staging criteria in 1997.3 The International Association for the Study of Lung Cancer (IASLC) recommended the classification of the status of VPI as follows: PL0, tumor grows within the parenchyma or does not completely penetrate the elastic layer; PL1, tumor extends beyond the elastic layer; PL2, tumor invades into the surface of the visceral pleura.[2,4]
Consistent with previous research,[8,9,10,11,12,13,14] our study revealed the association of the examined lymph nodes (LNs) count with survival
Summary
Lung cancer has been identified as the leading cause of cancer death for decades with a high incidence worldwide.[1]. Whenever possible, is generally the preferred treatment modality for early stage NSCLC.[2]. Previous studies illustrated the phenomenon that survival rate improved as more LNs were dissected in surgically resected NSCLC.[8,9,10,11] For example, Liang and colleagues studied the relationship between the examined LNs count and survival in NSCLC and identified 16 examined LNs as the optimal cut‐off point for evaluating the quality and thoroughness of LNs dissection.[8] Samayoa et al confirmed that survival of surgically resected node‐negative NSCLC patients was closely associated with the thoroughness of lymphadenectomy and recommended that at least 10 LNs should be examined.[10] As far as we know, none of those previous studies explored the impact of the status of VPI on the correlation between the extent of lymphadenectomy and survival in stage I NSCLC. The goal of our present study was to determine whether patients with T1‐sized/VPI tumors (stage IB) required more extensive LNs dissection to optimize survival than those with T1‐sized/non‐VPI tumors (stage IA), using a large population‐based database
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