Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis.

Xiongfeng Huang,Jianmin Wang,Qiao Chen,Jielin Jiang,Hyun-Sung Lee

doi:10.1371/journal.pone.0109979

Xiongfeng Huang, Jianmin Wang + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0109979

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Journal: PloS one	Publication Date: Oct 8, 2014
Citations: 49	License type: CC BY 4.0

Affiliation: Jiangxi University of Traditional Chinese Medicine

Abstract

ObjectiveThis systematic review and meta-analysis aimed to evaluate the overall survival, local recurrence, distant metastasis, and complications of mediastinal lymph node dissection (MLND) versus mediastinal lymph node sampling (MLNS) in stage I–IIIA non-small cell lung cancer (NSCLC) patients.MethodsA systematic search of published literature was conducted using the main databases (MEDLINE, PubMed, EMBASE, and Cochrane databases) to identify relevant randomized controlled trials that compared MLND vs. MLNS in NSCLC patients. Methodological quality of included randomized controlled trials was assessed according to the criteria from the Cochrane Handbook for Systematic Review of Interventions (Version 5.1.0). Meta-analysis was performed using The Cochrane Collaboration’s Review Manager 5.3. The results of the meta-analysis were expressed as hazard ratio (HR) or risk ratio (RR), with their corresponding 95% confidence interval (CI).ResultsWe included results reported from six randomized controlled trials, with a total of 1,791 patients included in the primary meta-analysis. Compared to MLNS in NSCLC patients, there was no statistically significant difference in MLND on overall survival (HR = 0.77, 95% CI 0.55 to 1.08; P = 0.13). In addition, the results indicated that local recurrence rate (RR = 0.93, 95% CI 0.68 to 1.28; P = 0.67), distant metastasis rate (RR = 0.88, 95% CI 0.74 to 1.04; P = 0.15), and total complications rate (RR = 1.10, 95% CI 0.67 to 1.79; P = 0.72) were similar, no significant difference found between the two groups.ConclusionsResults for overall survival, local recurrence rate, and distant metastasis rate were similar between MLND and MLNS in early stage NSCLC patients. There was no evidence that MLND increased complications compared with MLNS. Whether or not MLND is superior to MLNS for stage II–IIIA remains to be determined.

Highlights

Lung cancer is a malignant lung tumor in which the cells of lung tissues grow uncontrollably
While it is commonly accepted that surgical staging of mediastinal lymph node dissection (MLND) is important, the therapeutic efficacy of MLND is still under debate, whereas MLND requires a more extensive mediastinal dissection than mediastinal lymph node sampling (MLNS) and may lead to more complications [7]
The results in our metaanalysis indicated that local recurrence rate, distant metastasis rate, and complications rate were similar, no significant difference found between the two groups

Summary

Introduction

Lung cancer is a malignant lung tumor in which the cells of lung tissues grow uncontrollably. Lung cancer is the most common cause of cancer-related death in both men and women. The most common form of the disease is NSCLC, which accounts for approximately 85% of lung cancers [2,3]. NSCLC may be curable by surgical resection, but the extent of lymph node removal required and the impact of mediastinal node removal remains controversial [4,5,6]. While it is commonly accepted that surgical staging of mediastinal lymph node dissection (MLND) is important, the therapeutic efficacy of MLND is still under debate, whereas MLND requires a more extensive mediastinal dissection than mediastinal lymph node sampling (MLNS) and may lead to more complications [7]

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Conclusion