Lymph Node Assessment and Impact on Survival in Video-Assisted Thoracoscopic Lobectomy or Segmentectomy

被引：47
作者：
Zhou, Haiyu
Tapias, Luis F.
Gaissert, Henning A.
Muniappan, Ashok
Wright, Cameron D.
Wain, John C.
Donahue, Dean M.
Morse, Christopher R.
Mathisen, Douglas J.
Lanuti, Michael
机构：
[1] Guangdong Gen Hosp, Dept Thorac Surg, Guangzhou, Guangdong, Peoples R China
[2] Southern Med Univ, Guangdong Acad Med Sci, Guangzhou, Guangdong, Peoples R China
[3] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Div Thorac Surg, Boston, MA USA
来源：
ANNALS OF THORACIC SURGERY | 2015年 / 100卷 / 03期
关键词：
CELL LUNG-CANCER; PROGNOSTIC-FACTOR; NUMBER; DISSECTION; LYMPHADENECTOMY; METASTASIS; VALIDATION; RESECTION; RATIO;
D O I：
10.1016/j.athoracsur.2015.04.034
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Background. The objective of this study was to evaluate the influence of total number of resected lymph nodes, lymph node ratio, and the number of lymph node stations sampled on prognosis in patients with early stage non-small cell lung cancer (NSCLC) treated with video-assisted thoracoscopic surgery (VATS). Methods. Five hundred and fifty patients who underwent VATS lobectomy or segmentectomy for early clinical stage NSCLC were retrospectively analyzed from 2006 to 2012. Disease-free survival (DFS) and overall survival (OS) were compared for cutoff values of total number of resected lymph nodes (RNs) and lymph node stations (LNS) using Kaplan-Meier methods and Cox proportional hazard models. Results. Lobectomy was performed in 493 (90%) patients with a median follow-up of 2.7 years. Median age was 68 (range, 29 to 92 years) and 342 (62%) were female. Pathologic stage I, II, and III was observed in 434 (79%), 80 (14.5%) and 36 (6.5%) patients, respectively. The N0, N1, and N2 pathologic nodal status was observed in 485 (88%), 38 (7%), and 27 (5%) patients, respectively. Nodal upstaging was observed in 11.3% (59 of 550) in the total cohort and 15% (49 of 332) in patients who underwent LNS greater than 3 compared with 5% (10 of 218) in patients with LNS 3 or less (p < 0.01). Multivariate analysis identified LNS greater than 3 as a negative independent predictor for DFS (hazard ratio 2.36, p = 0.003) and OS (hazard ratio 1.77, p = 0.046). Conclusions. Sampling greater than 3 LNS and greater than 10 RNs was associated with an increase in nodal upstaging. Only LNS greater than 3 was found to be an independent predictor of mortality in VATS lobectomy and segmentectomy in clinical early-stage NSCLC. (C) 2015 by The Society of Thoracic Surgeons
引用
收藏
页码：910 / 917
页数：8
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