Appropriate Extent of Lymphadenectomy in Segmentectomy: A Multicenter Study

Abstract Background The significance of lymphadenectomy is yet to be fully examined in segmentectomy. We compared the oncological outcomes of mediastinal lymph node dissection (LND) and hilar LND for lung cancer treated with segmentectomy via a multicenter database using propensity score-matched analysis. Methods We reviewed 357 clinical stage IA radiologically solid-dominant lung cancer patients who underwent segmentectomy with lymphadenectomy. The extent of LND was classified into systematic/lobe-specific mediastinal LND and hilar LND only groups. Postoperative results after segmentectomy with mediastinal LND (n = 179) and hilar LND (n = 178) were analyzed for all patients and their propensity score-matched pairs. Results Cancer-specific survival (CSS) and recurrence-free interval (RFI) rates for the mediastinal LND group were determined to be not significantly different compared with the hilar LND group in all non-adjusted cohorts. In the propensity score-matched cohort (129 pairs), mediastinal LND harvested more lymph nodes compared with hilar LND, and both groups had significantly different pathological stages (P = 0.015). Adjuvant chemotherapy was performed in 10 (7.8%) patients in the mediastinal LND group and 4 (3.1%) in the hilar LND group. The mediastinal LND group tended to have better prognosis than the hilar LND group (5-year CSS rates, 97.4% vs 93.2%; 5-year RFI rates, 93.5% vs 88.5%). Conclusions Mediastinal LND was found to provide more appropriate pathological staging compared with hilar LND in patients with segmentectomy by harvesting more lymph nodes. In addition, mediastinal LND might lead to better oncological outcome than hilar LND in segmentectomy.

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Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezw400 ◽

2017 ◽

Vol 51 (4) ◽

pp. 674-679 ◽

Cited By ~ 23

Author(s):

Andrea Bille ◽

Kaitlin M. Woo ◽

Usman Ahmad ◽

Nabil P. Rizk ◽

David R. Jones

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Lymph Node Dissection ◽

Mediastinal Lymph Node ◽

Clinical Stage ◽

Stage I ◽

Node Dissection ◽

Lung Cancer Patients ◽

Stage I Lung Cancer

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Comparison of the outcomes of stereotactic body radiotherapy versus surgical treatment for elderly (≥70) patients with early-stage non-small cell lung cancer after propensity score matching

Radiation Oncology ◽

10.1186/s13014-019-1399-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Baiqiang Dong ◽

Jin Wang ◽

Xuan Zhu ◽

Yuanyuan Chen ◽

Yujin Xu ◽

...

Keyword(s):

Lung Cancer ◽

Surgical Treatment ◽

Propensity Score ◽

Elderly Patients ◽

Stereotactic Body Radiotherapy ◽

Early Stage ◽

Clinical Stage ◽

Small Cell ◽

Small Cell Lung ◽

Cancer Specific Survival

Abstract Background The optimal treatment for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains inconclusive. Previous studies have shown that stereotactic body radiotherapy (SBRT) provides encouraging local control though higher incidence of toxicity in elderly than younger populations. The objective of this study was to compare the outcomes of SBRT and surgical treatment in elderly patients with clinical stage I-II NSCLC. Methods This retrospective analysis included 205 patients aged ≥70 years with clinical stage I NSCLC who underwent SBRT or surgery at Zhejiang Cancer Hospital (Hangzhou, China) from January 2012 to December 2017. A propensity score matching analysis was performed between the two groups. In addition, we compared outcomes and related toxicity in both study arms. Results Each group included 35 patients who met the inclusion criteria. Median follow-up was 50.1 (0.8–74.4) months for surgery and 35.5 (11.5–71.4) months for SBRT. The rate of cancer-specific survival was similar between the two treatment arms (p = 0.958). In patients who underwent surgery, the corresponding 3- and 5-year cancer-specific survival rates were 85.3 and 81.7%, respectively. In those who received radiotherapy, these rates were 91.3 and 74.9%, respectively. Moreover, the 3- and 5-year locoregional control in patients who underwent surgery were 90.0 and 80.0%, respectively. In those who received radiotherapy, these rates were 91.1 and 84.1%, respectively. Notably, the observed differences in progression-free survival were not statistically significant (p = 0.934). In the surgery group, grade 1–2 complications were observed in eleven patients (31%). One patient died due to perioperative infection within 30 days following surgery. There was no grade 3–5 toxicity observed in the SBRT group. Conclusions The outcomes of surgery and SBRT in elderly patients with early-stage NSCLC were similar.

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