Chen Yan, Zhang Jing, Chen Linsong, Dai Jie, Hu Junjie, Zhu Xinsheng, Zhang Kaixuan, Yu Huansha, Zhang Haiping, Fei Ke, Zhang Peng
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Ann Surg Oncol. 2021 Mar;28(3):1810-1818. doi: 10.1245/s10434-020-08975-9. Epub 2020 Sep 5.
This study aims to investigate the effect of lymph node examination on overall survival (OS) and lung cancer-specific survival (LCSS) in stage I second primary lung cancer (SPLC) patients who underwent second pulmonary resection.
We conducted a retrospective study with the Surveillance, Epidemiology, and End Results (SEER) database to identify stage I SPLC patients who received surgery from 1998 to 2015. The Kaplan-Meier method with landmark analysis and multivariable Cox regression analysis were performed to evaluate the prognostic value of lymph node examination.
A total of 842 patients from the SEER database with stage I SPLC who underwent a second surgical treatment were included. The 5-year survival rate was 54.8% for the whole cohort. Multivariable analysis revealed that the number of lymph nodes examined (LNE) was associated with better OS and LCSS in SPLC patients after 12 months postoperatively. Patients with contralateral SPLC had significantly more nodes removed than those with ipsilateral SPLC. For contralateral SPLC, more than 10 LNE was correlated with improved long-term survival outcomes. Ipsilateral SPLC patients benefited from 4 or more LNE. However, the current analysis did not show a significant survival benefit from lymph node examination within 12 months after surgery.
For stage I SPLC patients who received surgical treatment after initial resection, an adequate number of LNE would improve both OS and LCSS. We recommend more than 10 LNE for contralateral SPLC and at least 4 LNE for ipsilateral SPLC.
本研究旨在调查淋巴结检查对接受二次肺切除的I期第二原发性肺癌（SPLC）患者总生存期（OS）和肺癌特异性生存期（LCSS）的影响。
我们利用监测、流行病学和最终结果（SEER）数据库进行了一项回顾性研究，以确定1998年至2015年接受手术的I期SPLC患者。采用带有标志性分析的Kaplan-Meier方法和多变量Cox回归分析来评估淋巴结检查的预后价值。
SEER数据库中共有842例接受二次手术治疗的I期SPLC患者被纳入研究。整个队列的5年生存率为54.8%。多变量分析显示，术后12个月，淋巴结检查数量（LNE）与SPLC患者更好的OS和LCSS相关。对侧SPLC患者切除的淋巴结明显多于同侧SPLC患者。对于对侧SPLC，LNE超过10个与改善长期生存结果相关。同侧SPLC患者从4个或更多LNE中获益。然而，目前的分析未显示术后12个月内淋巴结检查有显著的生存获益。
对于初次切除后接受手术治疗的I期SPLC患者，足够数量的LNE可改善OS和LCSS。我们建议对侧SPLC的LNE超过10个，同侧SPLC至少4个。
