Dept of Surgery, Máxima MC, Veldhoven, The Netherlands.
Dept of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Eur Respir J. 2021 Apr 1;57(4). doi: 10.1183/13993003.01549-2020. Print 2021 Apr.
Guidelines for invasive mediastinal nodal staging in resectable nonsmall cell lung cancer (NSCLC) have changed over the years. The aims of this study were to describe trends in invasive staging and unforeseen N2 (uN2) and to assess a potential effect on overall survival.
A nationwide Dutch cohort study included all clinical stage IA-IIIB NSCLC patients primarily treated by surgical resection between 2005 and 2017 (n=22 555). We assessed trends in invasive nodal staging (mediastinoscopy 2005-2017; endosonography 2011-2017), uN2 and overall survival and compared outcomes in the entire group and in clinical nodal stage (cN)1-3 patients with or without invasive staging.
An overall increase in invasive nodal staging from 26% in 2005 to 40% in 2017 was found (p<0.01). Endosonography increased from 19% in 2011 to 32% in 2017 (p<0.01), while mediastinoscopy decreased from 24% in 2011 to 21% in 2017 (p=0.08). Despite these changes, uN2 was stable over the years at 8.7%. 5-year overall survival rate was 41% for pN1 compared to 37% in single node uN2 (p=0.18) and 26% with more than one node uN2 (p<0.01). 5-year overall survival rate of patients with cN1-3 with invasive staging was 44% 39% in patients without invasive staging (p=0.12).
A significant increase in invasive mediastinal nodal staging in patients with resectable NSCLC was found between 2011 and 2017 in the Netherlands. Increasing use of less invasive endosonography prior to (or as a substitute for) surgical staging did not lead to more cases of uN2. Performance of invasive staging indicated a possible overall survival benefit in patients with cN1-3 disease.
可切除非小细胞肺癌（NSCLC）的侵袭性纵隔淋巴结分期指南多年来发生了变化。本研究的目的是描述侵袭性分期和意外 N2（uN2）的趋势，并评估其对总生存的潜在影响。
一项全国性的荷兰队列研究纳入了 2005 年至 2017 年间主要通过手术切除治疗的临床分期为 IA-IIIB 的所有 NSCLC 患者（n=22555）。我们评估了侵袭性淋巴结分期（纵隔镜检查 2005-2017 年；超声内镜检查 2011-2017 年）、uN2 和总生存率的趋势，并比较了整个组以及有或无侵袭性分期的临床淋巴结分期（cN）1-3 患者的结果。
发现侵袭性淋巴结分期总体从 2005 年的 26%增加到 2017 年的 40%（p<0.01）。超声内镜检查从 2011 年的 19%增加到 2017 年的 32%（p<0.01），而纵隔镜检查从 2011 年的 24%减少到 2017 年的 21%（p=0.08）。尽管发生了这些变化，但 uN2 多年来保持稳定，为 8.7%。pN1 的 5 年总生存率为 41%，而单个淋巴结 uN2 为 37%（p=0.18），多个淋巴结 uN2 为 26%（p<0.01）。有 cN1-3 侵袭性分期的患者的 5 年总生存率为 44%，无侵袭性分期的患者为 39%（p=0.12）。
荷兰 2011 年至 2017 年间，可切除 NSCLC 患者的侵袭性纵隔淋巴结分期显著增加。在（或替代）手术分期之前，越来越多地使用微创超声内镜检查并未导致更多的 uN2 病例。侵袭性分期的实施表明，cN1-3 疾病患者的总生存可能受益。
