Abstract
BackgroundTo compare survival of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection and lymph node sampling based on guidelines proposed by the American College of Surgeons Oncology Group (ACOSOG), National Comprehensive Cancer Network (NCCN), the OSI Pharmaceutical RADIANT trial, and the International Association for the Study of Lung Cancer (IASLC).MethodsMedical records of patients with NSCLC who underwent surgical resection from 2001 to 2008 at our hospital were reviewed. Staging was according to the 7th edition of the AJCC TNM classification of lung cancer. Patients who received surgical resection following the IASLC, ACOSOG, RADIANT or NCCN resection criteria were identified.ResultsA total of 2,711 patients (1803 males, 908 females; mean age, 59.6 ± 9.6 years) were included. Multivariate Cox proportional hazards regression analysis indicated that increasing age, adenosquamous histology, and TNM stage II or III were associated with decreased overall survival (OS). Univariate analysis and log-rank test showed that surgical resection following the guidelines proposed by the IASLC, NCCN, ACOSOG, or RADIANT trial was associated with higher cumulative OS rates (relative to resection not following the guidelines). Multivariate analysis revealed that there was a significant improvement in OS only when IASLC resection guidelines (complete resection) were followed (hazard ratio = 0.84, 95% confidence interval 0.716 to 0.985, P = 0.032).ConclusionsSurgical resection following the criteria proposed by IASLC, NCCN, ACOSOG, or the RADIANT trial was associated with a higher cumulative OS rate. However, significant improvement in OS only occurred when IASLC resection guidelines were followed.
Highlights
To compare survival of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection and lymph node sampling based on guidelines proposed by the American College of Surgeons Oncology Group (ACOSOG), National Comprehensive Cancer Network (NCCN), the OSI Pharmaceutical RADIANT trial, and the International Association for the Study of Lung Cancer (IASLC)
Only 56% of patients clinically staged as having stage I NSCLC had pathologic stage I disease while 6.8% of patients clinically staged as having greater than stage I had pathologic stage I disease, suggesting that complete thoracic lymphadenectomy improve the staging of patients with NSCLC
Patients were included in the study if they had a diagnosis of NSCLC confirmed by pathological tissue examination and underwent surgical resection
Summary
To compare survival of patients with non-small cell lung cancer (NSCLC) who underwent surgical resection and lymph node sampling based on guidelines proposed by the American College of Surgeons Oncology Group (ACOSOG), National Comprehensive Cancer Network (NCCN), the OSI Pharmaceutical RADIANT trial, and the International Association for the Study of Lung Cancer (IASLC). In the United States, an estimated 228,190 new cases of lung cancer are expected in 2013, accounting for about 14% of cancer diagnoses [2]. Accurate staging is a critical aspect of the diagnostic work-up of patients with NSCLC, with disease stage influencing decisions regarding the type and timing of treatments [5]. Surgical resection remains the primary treatment for patients with stage I and II NSCLC [6,7]. The role of surgery for stage III disease is controversial, while patients with stage IIIB or IV tumors are rarely surgical candidates [7]. Cerfolio et al [8] reported that about 14% NSCLC patients were clinically over-staged (benign nodules) and 32% were clinically under-staged (most from nonimaged N2 disease). Only 56% of patients clinically staged as having stage I NSCLC had pathologic stage I disease while 6.8% of patients clinically staged as having greater than stage I had pathologic stage I disease, suggesting that complete thoracic lymphadenectomy improve the staging of patients with NSCLC
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