The role of segmental nodes in the pathological staging of non-small cell lung cancer

Clinical significance of intrapulmonary lymph node dissection in pathological stage IA non-small cell lung cancer: A propensity score matching analysis

Background

This study aimed to investigate the prognostic impact of intrapulmonary lymph node (ILN, stations 13–14) dissection on disease‐free survival (DFS) in stage IA non‐small cell lung cancer (NSCLC) patients in order to facilitate a more suitable determination of surgical strategies for early‐stage cases.

Methods

We retrospectively analyzed 416 patients with pathological stage IA NSCLC from February 2016 to November 2019. The patients were divided into a group with ILN dissection (ILN^D+ group) and a group without ILN dissection (ILN^D‐ group). DFS was compared using the Kaplan–Meier method and compared statistically using the log‐rank test before and after propensity score matching (PSM). Subgroup analysis of DFS stratified based on tumor size was also calculated.

Results

Both before and after PSM, the four‐year DFS of the ILN^D+ group was greatly increased compared to that of ILN^D‐ group (90.1% vs. 79.7%, p = 0.003; 95.5% vs. 80.6%, p = 0.003, respectively) and multivariable cox regression analysis revealed ILN dissection was an independent factor favoring DFS in stage IA NSCLC (p = 0.016 and p = 0.015, respectively). Subgroup analysis revealed the four‐year DFS was comparable between the ILN ^D+ and ILN^D‐ groups with regard to tumor size ≤1.5 cm (90.6% vs. 92.7%, p = 0.715). However, the ILN ^D+ group was found to have a better oncological outcome compared with the ILN^D‐ group with regard to tumor size >1.5 cm (90.0% vs. 73.8%, p = 0.003).

Conclusions

The prognostic impact of ILN dissection on patients with stage IA NSCLC appears to be significantly influenced by tumor size, and this should be taken into account when choosing the most appropriate therapeutic modality.

Adjuvant chemotherapy may improve outcome of patients with non-small-cell lung cancer with metastasis of intrapulmonary lymph nodes after systematic dissection of N1 nodes

Objective

Survival benefit of adjuvant chemotherapy (AC) of patients with intrapulmonary lymph node (IPLN) metastasis (level 12−14) needs investigation. We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.

Methods

First, 155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated. Patients received systematic dissection of N2 and N1 nodes. For patients with IPLN metastasis, survival outcomes were compared between those receiving AC and those not receiving AC.

Results

In this group, 112 cases (72.3%) had IPLN metastasis and 55 cases (35.5%) had N1 involvement limited to level 13−14 without further disease spread to higher levels. Patients with IPLN involvement had a better prognosis than that of patients with hilar-interlobar involvement. For the intrapulmonary N1 group (level 12−14-positive, level 10−11-negative or unknown, n=112), no survival benefit was found between the AC group and non-AC group [5-year overall survival (OS): 54.6±1.6vs. 50.4±2.4 months, P=0.177]. However, 76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports (level 12−14-positive, level 10−11 both negative), oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup (5-year OS: 57.3±1.5vs. 47.1±3.2 months, P=0.002).

Conclusions

Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.

[Surgical Quality Surveillance and Sustaining Improvement of Lung Cancer Surgery Based on Standard Operation Procedure (SOP): Experience of Single Surgical Team]

背景与目的

医疗流程标准化可提高治疗规范程度、控制合并症和住院时间，但国家制定的临床路径需根据各中心实际情况进行个体化调整。

方法

本研究分析单一手术组进行肺切除手术患者的围手术期信息，通过对比术后平均住院日、医疗费用、手术胸腔镜占比等多个因素，从结构性指标、过程性指标、结果性指标三个方面进行了手术质量持续改进的总结和探索，寻找适合本手术组实际情况的理想术后住院时间及质量评估指标。

结果

2016年的术后平均住院日较2013年明显缩短[(4.08±1.80) d vs (6.13±3.60) d, P < 0.001]，全胸腔镜手术占比（17%→48%→68%→73%）及单操作孔胸腔镜占比（0%→2%→52%→66%）四年来显著提高。

结论

通过外科单元进行自我质量监控和改进，能够显著降低术后平均住院日，减少术后并发症发生。