Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee.
Ann Thorac Surg. 2013 Oct;96(4):1178-1189. doi: 10.1016/j.athoracsur.2013.05.021. Epub 2013 Jul 30.
Nonexamination of lymph nodes is an extreme example of the variability of pathologic nodal staging of non-small cell lung cancer. We compared the prevalence, characteristics, and survival of patients without lymph nodes (pNX) to patients with documented pathologic N0 and pathologic N1 non-small cell lung cancer.
A retrospective analysis was done of non-small cell lung cancer resections in the US Surveillance, Epidemiology, and End Results database from 1998 to 2009.
Thirteen percent of all resections (18% of node negative resections) were pNX, including 6% of all node-negative lobar or greater resections and 51% of sublobar resections. Thirty-five percent of pNX resections were lobar or greater compared with 90% of pathologic N0 (p < 0.0001). Advanced age and surgery in rural locations were also significantly associated with pNX resection. The median duration of survival was 3 years in the pNX cohort, 6.4 years in the N0 cohort (p < 0.0001), and 2.8 years in the N1 group, with respective 5-year survival rates of 47%, 67%, and 45% (p < 0.0001). These survival differences remained after adjustment for potentially confounding factors.
Patients with pNX resections are a high-risk subset, with survival approximating pathologic N1, not N0. They should have further attempts at retrieving lymph nodes for examination or be offered postoperative adjuvant chemotherapy. We predict that treatment modalities that fail to address lymph nodes are likely to yield inferior survival in comparison to surgery with proper lymph node examination. The proportion of pNX lung resections may be a sentinel quality indicator for lung cancer programs.
非淋巴结检查是 NSCLC 病理淋巴结分期变异性的一个极端例子。我们比较了无淋巴结（pNX）患者与有记录的病理 N0 和病理 N1 NSCLC 患者的患病率、特征和生存率。
对 1998 年至 2009 年美国监测、流行病学和最终结果数据库中进行的非小细胞肺癌切除术进行了回顾性分析。
所有切除手术的 13%（所有淋巴结阴性切除手术的 18%）为 pNX，包括所有淋巴结阴性肺叶或更大切除手术的 6%和亚肺叶切除手术的 51%。与病理 N0 相比，pNX 切除手术中 35%为肺叶或更大，而病理 N0 为 90%（p<0.0001）。高龄和农村地区手术也是与 pNX 切除相关的显著因素。pNX 组的中位生存时间为 3 年，N0 组为 6.4 年（p<0.0001），N1 组为 2.8 年，相应的 5 年生存率分别为 47%、67%和 45%（p<0.0001）。这些生存差异在调整了潜在混杂因素后仍然存在。
pNX 切除手术患者是一个高危亚组，其生存情况接近病理 N1，而不是 N0。他们应进一步尝试取淋巴结进行检查，或提供术后辅助化疗。我们预测，未能解决淋巴结问题的治疗方法可能会导致与适当淋巴结检查的手术相比，生存率降低。pNX 肺切除手术的比例可能是肺癌项目的一个有代表性的质量指标。
