Pathologic Lymph Node Staging Practice and Stage-Predicted Survival After Resection of Lung Cancer

• Published in: The Annals of thoracic surgery Vol. 91; no. 5; pp. 1486 - 1492
• Main Authors: Osarogiagbon, Raymond U., MD, Allen, Jeffrey W., MD, Farooq, Aamer, MD, Berry, Allen, MD, O'Brien, Thomas, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2011; Elsevier
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biopsy, Needle; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Cardiology. Vascular system; Cardiothoracic Surgery; Cause of Death; Cohort Studies; Disease-Free Survival; Education, Medical, Continuing; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Staging - methods; Pneumology; Pneumonectomy - methods; Pneumonectomy - mortality; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Sex Factors; Statistics, Nonparametric; Surgery; Survival Analysis; Treatment Outcome; Tumors of the respiratory system and mediastinum; 10; Lung disease; Prognosis; Lymph node; Respiratory disease; Lung cancer; Surgical resection; Malignant tumor; Survival; Treatment; Surgery; Professional practice; Bronchus disease; Anesthesia; Circulatory system; Cardiology; Predictive factor; Cancer
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2010.11.065

Background Lymph node status is the most important prognostic factor in resectable nonsmall-cell lung cancer (NSCLC). We examined the relationship between the pattern of lymph node examination (including the number and anatomic location of resected lymph nodes), pathologic nodal stage, and survival after NSCLC resection. Methods Retrospective review of all NSCLC resections in the Memphis Metropolitan Area from January 1, 2004, to December 31, 2007. Results In 656 resections, the number of lymph nodes examined differed significantly between patients grouped by pathologic nodal stage ( p < 0.0001) and extent of resection ( p < 0.001). Thirty-seven percent of “mediastinal node-negative” patients had no mediastinal lymph nodes examined. Patients with pN1 and no mediastinal lymph nodes had significantly worse survival than patients with mediastinal lymph node examination ( p < 0.02). Approximately 10% of patients with pN0 and pN2 disease had no hilar/intrapulmonary lymph nodes examined. Conclusions Suboptimal lymph node staging was prevalent in this cohort. Large proportions of pN1 and pN0 patients were probably understaged. For patients with positive pulmonary/hilar lymph nodes, failure to examine mediastinal lymph nodes was associated with poorer survival. Interventions are needed to improve lymph node staging of NSCLC.