Identifying Outlier Hospitals in Gastric Cancer Lymph Node Yield Using the National Cancer Database

Objectives (1) To estimate the association between neck dissection lymph node yield (LNY) and survival among patients with surgically treated human papilloma virus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC). (2) To identify a clinically relevant quality metric for surgical treatment of HPV-related OPSCC. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods From the National Cancer Database, 4130 patients were identified with HPV-associated OPSCC treated with primary surgery from 2010 to 2016. Based on prior literature, an adequate neck dissection LNY was defined as ≥18 lymph nodes. To determine whether LNY is associated with survival, univariable and multivariable Cox proportional hazards regression was performed. Analysis was stratified by adjuvant therapy regimen. Results A total of 2113 patients (51.2%) underwent surgery with or without adjuvant radiation (S ± RT), and 2017 patients (48.8%) underwent surgery with adjuvant chemoradiation. LNY ≥18 was associated with a 5-year survival benefit of 7.15% (91.7% for LNY ≥18, 84.5% for LNY <18, P = .004) for the S ± RT cohort on unadjusted survival analysis. For the S ± RT group, LNY ≥18 was associated with decreased hazard of death (hazard ratio, 0.45; 95% CI, 0.29-0.70; P < .001) after adjustment for patient characteristics, TNM staging, surgical margins, extranodal extension, and treating facility characteristics. For surgery with adjuvant chemoradiation, the adjusted hazard ratio estimate for LNY ≥18 was 0.64 (95% CI, 0.41-1.00), but the result was not statistically significant ( P = .052). Conclusion An adequate LNY from a neck dissection may affect survival when HPV-related OPSCC is treated with up-front surgery.

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Prognostic Value of Lymph Node Yield After Neoadjuvant Chemoradiation for Gastric Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-019-07840-8 ◽

2019 ◽

Vol 27 (2) ◽

pp. 534-542 ◽

Cited By ~ 2

Author(s):

Casey J. Allen ◽

Timothy J. Vreeland ◽

Timothy E. Newhook ◽

Prajnan Das ◽

Bruce D. Minsky ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Prognostic Value ◽

Neoadjuvant Chemoradiation ◽

Lymph Node Yield ◽

Node Yield

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Comparative Analysis of Station-specific Lymph Node Yield in Laparoscopic and Open Distal Gastrectomy for Early Gastric Cancer

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0b013e3182367dee ◽

2011 ◽

Vol 21 (6) ◽

pp. 424-428 ◽

Cited By ~ 8

Author(s):

George Bouras ◽

Sang-Woong Lee ◽

Eiji Nomura ◽

Takaya Tokuhara ◽

Soichiro Tsunemi ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Comparative Analysis ◽

Early Gastric Cancer ◽

Distal Gastrectomy ◽

Open Distal Gastrectomy ◽

Lymph Node Yield ◽

Node Yield

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Comparative Analysis of Robotic Segmentectomy For Non-Small Cell Lung Cancer: A National Cancer Database Study

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984521997805 ◽

2021 ◽

pp. 155698452199780

Author(s):

Karishma Kodia ◽

Syed S. Razi ◽

Ahmed Alnajar ◽

Dao M. Nguyen ◽

Nestor Villamizar

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Lymph Node ◽

Small Cell Lung Cancer ◽

Clinical Outcomes ◽

Small Cell ◽

National Cancer Database ◽

Small Cell Lung ◽

Lymph Node Yield ◽

Node Yield

Objective The use of segmentectomy for peripheral T ≤2 cm, N0 non-small cell lung cancer (NSCLC) has increased in the last decade. We sought to compare clinical outcomes and overall survival between robotic, video-assisted thoracoscopic surgery (VATS), and open segmentectomy. Methods The National Cancer Database was queried for patients with clinical T ≤2 cm, N0 NSCLC who underwent segmentectomy via robotic, thoracoscopic (VATS), and open approaches (2010 to 2015). Univariate and Cox regression analyses were used to compare surgical approaches and to evaluate predictors of overall survival. Statistical analyses were done using SPSS Version 21.0. Results Segmentectomy was performed in 3,888 patients during the study period with 406 robotic, 1,837 VATS, and 1,645 open patients. VATS and robotic segmentectomy were performed more often at academic or comprehensive community cancer programs as compared to community programs ( P < 0.05). Conversion to open thoracotomy was similar between robotic and VATS groups when stratified by hospital volume. Lymph node yield was significantly higher for robotic (median = 6), compared to VATS (median = 5) or open (median = 4; P < 0.001). Length of stay was decreased for robotic versus open ( P < 0.01). No differences in 30-day readmissions ( P = 0.12) were observed among the 3 modalities. Overall survival was similar among groups ( P = 0.18). Conclusions Robotic segmentectomy provides similar clinical outcomes compared to other standardized approaches for clinical T ≤2 cm, N0 NSCLC. A higher lymph node yield in robotic segmentectomy was not associated with improved survival in this study population.

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The effect of preoperative chemotherapy on lymph node yield in gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.80 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 80-80

Author(s):

J. L. Dikken ◽

P. Krijnen ◽

C. J. Van De Velde ◽

M. Verheij ◽

M. Gonen ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Preoperative Chemotherapy ◽

Distal Gastrectomy ◽

High Volume ◽

Curative Surgery ◽

Lymph Node Yield ◽

Younger Age ◽

Node Yield ◽

The U.S

80 Background: While a minimum of 15 lymphnodes (LNs) should be evaluated for accurate staging of gastric cancer, LN yield in western countries is generally low. With the increasing use of preoperative chemotherapy, it is unknown what the effect of this treatment is on lymph node yield. The aim of the study is therefore to determine whether preoperative chemotherapy influences the number of LNs that can be obtained from specimens of patients who underwent curative surgery for gastric adenocarcinoma. Methods: In1,205 patients from a high-volume U.S. center and 1,220 patients from the Netherlands Cancer Registry (NCR) who underwent a total or distal gastrectomy with curative intent for gastric adenocarcinoma, the LN yield was compared between patients who received preoperative chemotherapy and patients who received no neoadjuvant therapy. Multivariate Poisson regression was used to identify significant predictors of LN retrieval. Results: Of the 2,425 patients who underwent a gastrectomy, 340 patients (14%) received preoperative chemotherapy. Median LN yields were 23 in the U.S. institution and 10 in the NCR. Separate multivariate analyses of the U.S. institution data and the NCR population showed in both groups that preoperative chemotherapy was not associated with a significant difference in LN yield (Table). Factors that were associated with higher LN yield were the same in both groups: female sex, younger age (6% more nodes with every 10 years decrease in age), total gastrectomy (vs. distal gastrectomy) and increasing tumor (T) stage. Conclusions: In both a high-volume cancer center, and a population-based cancer registry, female sex, younger age, total gastrectomy and advanced tumor stage were associated with an increase in lymph node retrieval in surgical specimens. Preoperative chemotherapy did not influence lymph node yield after a resection for gastric cancer. The threshold for what should constitute an adequate assessment of regional lymph nodes after curative surgery for gastric cancer should not be changed after administration of preoperative chemotherapy. [Table: see text] No significant financial relationships to disclose.

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A greater lymph node yield is required during pathological examination in microsatellite instability-high gastric cancer

BMC Cancer ◽

10.1186/s12885-021-08044-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhenghao Cai ◽

Haiqin Song ◽

Abe Fingerhut ◽

Jing Sun ◽

Junjun Ma ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Microsatellite Instability ◽

Pathological Examination ◽

Curative Gastrectomy ◽

Lymph Node Yield ◽

Log Odds ◽

Microsatellite Stability ◽

The Impact ◽

Node Yield

Abstract Background The impact of microsatellite status on lymph node (LN) yield during lymphadenectomy and pathological examination has never been assessed in gastric cancer (GC). In this study, we aimed to appraise the association between microsatellite instability-high (MSI-H) and LN yield after curative gastrectomy. Methods We retrospectively analyzed 1757 patients with GC undergoing curative gastrectomy and divided them into two groups: MSI-H (n = 185(10.5%)) and microsatellite stability (MSS) (n = 1572(89.5%)), using a five-Bethesda-marker (NR-24, BAT-25, BAT-26, CAT-25, MONO-27) panel. The median LN count and the percentage of specimens with a minimum of 16 LNs (adequate LN ratio) were compared between the two groups. The log odds (LODDS) of positive LN count (PLNC) to negative LN count (NLNC) and the target LN examined threshold (TLNT(x%)) were calculated in both groups. Results Statistically significant differences were found in the median LN count between MSI-H and MSS groups for the complete cohort (30 vs. 28, p = 0.031), for patients undergoing distal gastrectomy (DG) (30 vs. 27, p = 0.002), for stage II patients undergoing DG (34 vs. 28, p = 0.005), and for LN-negative patients undergoing DG (28 vs. 24, p = 0.002). MSI-H was an independent factor for higher total LN count in patients undergoing DG (p = 0.011), but it was not statistically correlated to the adequate LN ratio. Statistically significant differences in PLNC, NLNC and LODDS were found between MSI-H GC and MSS GC (all p < 0.001). The TLNT(90%) for MSI-H and MSS groups were 31 and 25, respectively. TLNT(X%) of MSI-H GC was always higher than that of MSS GC regardless of the given value of X%. Conclusions MSI-H was associated with higher LN yield in patients undergoing gastrectomy for GC. Although MSI-H did not affect the adequacy of LN harvest, we speculate that a greater lymph node yield is required during pathological examination in MSI-H GC.

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Outcomes of Inadequate Examined Lymph Node Yield on Pathologic T3N0M0 Colon Cancer Cases Undergoing Surgical Resection with Clear Margins: A National Cancer Database Study

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.08.088 ◽

2021 ◽

Vol 233 (5) ◽

pp. e32

Author(s):

Thais Reif de Paula ◽

Elizabeth R. Raskin ◽

Deborah S. Keller

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Surgical Resection ◽

National Cancer Database ◽

Lymph Node Yield ◽

Database Study ◽

Node Yield

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Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000621 ◽

2021 ◽

pp. 1-8

Author(s):

K Devaraja ◽

K Pujary ◽

B Ramaswamy ◽

D R Nayak ◽

N Kumar ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Head And Neck ◽

Neck Dissection ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

En Bloc ◽

Lymph Node Yield ◽

Node Yield

Abstract Background Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. Methods This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. Results From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). Conclusion Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

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