Zhang Yudong, Zhang Yichi, Cheng Xinxin, Dai Keyao, Xu Bo, Liang Shujun, Chen Minsheng, Zhang Honglang, Chen Zhenguang
Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2022 May 5;12:853257. doi: 10.3389/fonc.2022.853257. eCollection 2022.
Selected patients with stage IV non-small cell lung cancer (NSCLC) who underwent primary tumor resection have witnessed a survival benefit. Whether additional lymph node dissection (LND) would result in a better effect remain unknown. We investigated the prognostic impact of LND on patients with stage IV NSCLC who received primary tumor resection (PTR).
Patients with stage IV NSCLC who underwent PTR were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2016. Propensity-score matching was performed to minimize the confounding effect, and lung cancer-specific survival (CSS) and overall survival (OS) were compared after matching. Multivariable Cox regression was used to identify prognostic factors and to adjust for covariates in subgroup analysis. The effect of the number of lymph nodes examined on the CSS was evaluated by repeating the Cox analysis in a binary method.
A total of 4,114 patients with stage IV NSCLC who receive surgery met our criteria, of which 2,622 (63.73%) underwent LND and 628 patients were identified 1:1 in LND and non-LND groups after matching. Compared with the non-LND group, the LND group had a longer CSS (median: 23 vs. 16 months, p < 0.001) and OS (median: 21 vs. 15 months, p < 0.001). Multivariable regression showed that LND was independently associated with favorable CCS [hazard ratio (HR) = 0.78, 95% confidence interval (CI) 0.69-0.89, P < 0.001] and OS (HR = 0.79, 95% CI 0.70-0.89, P < 0.001). Subgroup analysis suggested that LND is an independent favorable predictor to survival in the surgical patients who were older age (>60 years old), female, T3-4, N0, and M1a stage and those who underwent sublobar resection. In addition, a statistically significant CCS benefit was associated with an increasing number of lymph nodes examined through 25 lymph nodes.
LND with a certain range of lymph nodes number examined was associated with improved survival for patients with stage IV NSCLC who received primary tumor resection. The results may have implications for guidelines on lymph nodes management in selective advanced NSCLC for surgery.
部分接受原发性肿瘤切除的IV期非小细胞肺癌（NSCLC）患者已显示出生存获益。额外的淋巴结清扫（LND）是否会产生更好的效果尚不清楚。我们研究了LND对接受原发性肿瘤切除（PTR）的IV期NSCLC患者的预后影响。
从2004年至2016年的监测、流行病学和最终结果数据库中识别出接受PTR的IV期NSCLC患者。进行倾向评分匹配以尽量减少混杂效应，并在匹配后比较肺癌特异性生存（CSS）和总生存（OS）。多变量Cox回归用于识别预后因素并在亚组分析中调整协变量。通过以二元方法重复Cox分析来评估检查的淋巴结数量对CSS的影响。
共有4114例接受手术的IV期NSCLC患者符合我们的标准，其中2622例（63.73%）接受了LND，匹配后在LND组和非LND组中按1:1比例识别出628例患者。与非LND组相比，LND组的CSS更长（中位数：23个月对16个月，p<0.001），OS也更长（中位数：21个月对15个月，p<0.001）。多变量回归显示，LND与良好的CCS独立相关[风险比（HR）=0.78，95%置信区间（CI）0.69-0.89，P<0.001]和OS（HR=0.79，95%CI 0.70-0.89，P<0.001）。亚组分析表明，LND是年龄较大（>60岁）、女性、T3-4、N0和M1a期的手术患者以及接受肺叶下切除的患者生存的独立有利预测因素。此外，通过检查25个淋巴结，CSS获益具有统计学意义，且与检查的淋巴结数量增加相关。
检查一定数量范围淋巴结的LND与接受原发性肿瘤切除的IV期NSCLC患者的生存改善相关。该结果可能对选择性晚期NSCLC手术的淋巴结管理指南有启示意义。
