Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer

Jie Dai, Ming Liu, Yang Yang, Qiuyuan Li, Nan Song, Gaetano Rocco, Alan D.L. Sihoe, Diego Gonzalez-Rivas, Hon Chi Suen, Wenxin He, Liang Duan, Jiang Fan, Deping Zhao, Haifeng Wang, Yuming Zhu, Chang Chen, Robert B Diasio, Gening Jiang, Ping Yang, Peng Zhang

Research output: Contribution to journalArticle

Abstract

Objective: To determine the optimal number of lymph nodes (LNs)examined and the role of adjuvant chemotherapy in stage I lung cancer. Methods: The National Cancer Database was queried for surgically treated patients with pathologic stage I lung cancer between 2006 and 2014 (N = 65,438). The optimal LN numbers were determined in the multivariate Cox model and were further validated in the cohort with clinical stage I disease (N = 117,112)in terms of nodal upstaging and prognostic stratification. The role of adjuvant chemotherapy in patients with suboptimal staging (number of LNs examined was less than than the optimum)was evaluated in each T stage. Results: The number of LNs examined correlated with tumor size (p < 0.001). There were increasing survival benefits with each additional LN examined—up to eight, nine, 10, and 11 nodes for patients with T1a, T1b, T1c, and T2a, respectively. Validation from the cohort with clinically staged disease showed that the threshold of eight to 11 LNs was an independent predictor of nodal upstaging (OR = 1.706, 95% confidence interval [CI]1.608–1.779)and survival outcome (hazard ratio = 0.890, 95% CI: 0.865–0.916). After propensity matching, adjuvant chemotherapy was associated with improved survival in patients with stage T2a disease having suboptimal staging (hazard ratio = 0.841, 95% CI: 0.714–0.990), but not in patients with stage T1a to T1c disease. Conclusion: LN evaluation was important for accurate staging and adequate treatment, and examinations of an increasing number of nodes for progressively higher T components (i.e., eight, nine, 10, and 11 nodes for T1a, T1b, T1c, and T2a tumors, respectively)seemed crucial to predict upstaging and survival outcomes. Adjuvant chemotherapy might be beneficial to patients with stage T2a disease who have suboptimal nodal staging.

Original languageEnglish (US)
JournalJournal of Thoracic Oncology
DOIs
StatePublished - Jan 1 2019

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Adjuvant Chemotherapy
Lung Neoplasms
Lymph Nodes
Survival
Confidence Intervals
Neoplasms
Proportional Hazards Models
Databases

Keywords

  • Adjuvant chemotherapy
  • lung cancer
  • lymph node
  • survival

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer. / Dai, Jie; Liu, Ming; Yang, Yang; Li, Qiuyuan; Song, Nan; Rocco, Gaetano; Sihoe, Alan D.L.; Gonzalez-Rivas, Diego; Suen, Hon Chi; He, Wenxin; Duan, Liang; Fan, Jiang; Zhao, Deping; Wang, Haifeng; Zhu, Yuming; Chen, Chang; Diasio, Robert B; Jiang, Gening; Yang, Ping; Zhang, Peng.

In: Journal of Thoracic Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Dai, J, Liu, M, Yang, Y, Li, Q, Song, N, Rocco, G, Sihoe, ADL, Gonzalez-Rivas, D, Suen, HC, He, W, Duan, L, Fan, J, Zhao, D, Wang, H, Zhu, Y, Chen, C, Diasio, RB, Jiang, G, Yang, P & Zhang, P 2019, 'Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer', Journal of Thoracic Oncology. https://doi.org/10.1016/j.jtho.2019.03.027
Dai, Jie ; Liu, Ming ; Yang, Yang ; Li, Qiuyuan ; Song, Nan ; Rocco, Gaetano ; Sihoe, Alan D.L. ; Gonzalez-Rivas, Diego ; Suen, Hon Chi ; He, Wenxin ; Duan, Liang ; Fan, Jiang ; Zhao, Deping ; Wang, Haifeng ; Zhu, Yuming ; Chen, Chang ; Diasio, Robert B ; Jiang, Gening ; Yang, Ping ; Zhang, Peng. / Optimal Lymph Node Examination and Adjuvant Chemotherapy for Stage I Lung Cancer. In: Journal of Thoracic Oncology. 2019.
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abstract = "Objective: To determine the optimal number of lymph nodes (LNs)examined and the role of adjuvant chemotherapy in stage I lung cancer. Methods: The National Cancer Database was queried for surgically treated patients with pathologic stage I lung cancer between 2006 and 2014 (N = 65,438). The optimal LN numbers were determined in the multivariate Cox model and were further validated in the cohort with clinical stage I disease (N = 117,112)in terms of nodal upstaging and prognostic stratification. The role of adjuvant chemotherapy in patients with suboptimal staging (number of LNs examined was less than than the optimum)was evaluated in each T stage. Results: The number of LNs examined correlated with tumor size (p < 0.001). There were increasing survival benefits with each additional LN examined—up to eight, nine, 10, and 11 nodes for patients with T1a, T1b, T1c, and T2a, respectively. Validation from the cohort with clinically staged disease showed that the threshold of eight to 11 LNs was an independent predictor of nodal upstaging (OR = 1.706, 95{\%} confidence interval [CI]1.608–1.779)and survival outcome (hazard ratio = 0.890, 95{\%} CI: 0.865–0.916). After propensity matching, adjuvant chemotherapy was associated with improved survival in patients with stage T2a disease having suboptimal staging (hazard ratio = 0.841, 95{\%} CI: 0.714–0.990), but not in patients with stage T1a to T1c disease. Conclusion: LN evaluation was important for accurate staging and adequate treatment, and examinations of an increasing number of nodes for progressively higher T components (i.e., eight, nine, 10, and 11 nodes for T1a, T1b, T1c, and T2a tumors, respectively)seemed crucial to predict upstaging and survival outcomes. Adjuvant chemotherapy might be beneficial to patients with stage T2a disease who have suboptimal nodal staging.",
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author = "Jie Dai and Ming Liu and Yang Yang and Qiuyuan Li and Nan Song and Gaetano Rocco and Sihoe, {Alan D.L.} and Diego Gonzalez-Rivas and Suen, {Hon Chi} and Wenxin He and Liang Duan and Jiang Fan and Deping Zhao and Haifeng Wang and Yuming Zhu and Chang Chen and Diasio, {Robert B} and Gening Jiang and Ping Yang and Peng Zhang",
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AU - Dai, Jie

AU - Liu, Ming

AU - Yang, Yang

AU - Li, Qiuyuan

AU - Song, Nan

AU - Rocco, Gaetano

AU - Sihoe, Alan D.L.

AU - Gonzalez-Rivas, Diego

AU - Suen, Hon Chi

AU - He, Wenxin

AU - Duan, Liang

AU - Fan, Jiang

AU - Zhao, Deping

AU - Wang, Haifeng

AU - Zhu, Yuming

AU - Chen, Chang

AU - Diasio, Robert B

AU - Jiang, Gening

AU - Yang, Ping

AU - Zhang, Peng

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To determine the optimal number of lymph nodes (LNs)examined and the role of adjuvant chemotherapy in stage I lung cancer. Methods: The National Cancer Database was queried for surgically treated patients with pathologic stage I lung cancer between 2006 and 2014 (N = 65,438). The optimal LN numbers were determined in the multivariate Cox model and were further validated in the cohort with clinical stage I disease (N = 117,112)in terms of nodal upstaging and prognostic stratification. The role of adjuvant chemotherapy in patients with suboptimal staging (number of LNs examined was less than than the optimum)was evaluated in each T stage. Results: The number of LNs examined correlated with tumor size (p < 0.001). There were increasing survival benefits with each additional LN examined—up to eight, nine, 10, and 11 nodes for patients with T1a, T1b, T1c, and T2a, respectively. Validation from the cohort with clinically staged disease showed that the threshold of eight to 11 LNs was an independent predictor of nodal upstaging (OR = 1.706, 95% confidence interval [CI]1.608–1.779)and survival outcome (hazard ratio = 0.890, 95% CI: 0.865–0.916). After propensity matching, adjuvant chemotherapy was associated with improved survival in patients with stage T2a disease having suboptimal staging (hazard ratio = 0.841, 95% CI: 0.714–0.990), but not in patients with stage T1a to T1c disease. Conclusion: LN evaluation was important for accurate staging and adequate treatment, and examinations of an increasing number of nodes for progressively higher T components (i.e., eight, nine, 10, and 11 nodes for T1a, T1b, T1c, and T2a tumors, respectively)seemed crucial to predict upstaging and survival outcomes. Adjuvant chemotherapy might be beneficial to patients with stage T2a disease who have suboptimal nodal staging.

AB - Objective: To determine the optimal number of lymph nodes (LNs)examined and the role of adjuvant chemotherapy in stage I lung cancer. Methods: The National Cancer Database was queried for surgically treated patients with pathologic stage I lung cancer between 2006 and 2014 (N = 65,438). The optimal LN numbers were determined in the multivariate Cox model and were further validated in the cohort with clinical stage I disease (N = 117,112)in terms of nodal upstaging and prognostic stratification. The role of adjuvant chemotherapy in patients with suboptimal staging (number of LNs examined was less than than the optimum)was evaluated in each T stage. Results: The number of LNs examined correlated with tumor size (p < 0.001). There were increasing survival benefits with each additional LN examined—up to eight, nine, 10, and 11 nodes for patients with T1a, T1b, T1c, and T2a, respectively. Validation from the cohort with clinically staged disease showed that the threshold of eight to 11 LNs was an independent predictor of nodal upstaging (OR = 1.706, 95% confidence interval [CI]1.608–1.779)and survival outcome (hazard ratio = 0.890, 95% CI: 0.865–0.916). After propensity matching, adjuvant chemotherapy was associated with improved survival in patients with stage T2a disease having suboptimal staging (hazard ratio = 0.841, 95% CI: 0.714–0.990), but not in patients with stage T1a to T1c disease. Conclusion: LN evaluation was important for accurate staging and adequate treatment, and examinations of an increasing number of nodes for progressively higher T components (i.e., eight, nine, 10, and 11 nodes for T1a, T1b, T1c, and T2a tumors, respectively)seemed crucial to predict upstaging and survival outcomes. Adjuvant chemotherapy might be beneficial to patients with stage T2a disease who have suboptimal nodal staging.

KW - Adjuvant chemotherapy

KW - lung cancer

KW - lymph node

KW - survival

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