Cao Jinlin, Xu Jinming, Yu Haojie, Qian Pengxu, Lv Wang, He Tianyu, Yuan Ping, Longo Filippo, Bertolaccini Luca, Yasufuku Kazuhiro, Rucker A Justin, Hu Jian
Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China.
Transl Lung Cancer Res. 2022 Jul;11(7):1453-1467. doi: 10.21037/tlcr-22-489.
Evidence on the importance of lymph node (LN) dissection during resection for small cell lung cancer (SCLC) is scarce. This study sought to investigate the clinical impact of the extent of lymphadenectomy on the survival of patients with SCLC.
Patients who underwent resection for primary SCLC between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) cancer registry. The patients were stratified based on the number of LNs dissected (0, 1-3, 4-11, and ≥12) via an X-Tile software analysis, and lung cancer-specific survival (LCSS) and overall survival (OS) were compared between these stratified groups using Kaplan-Meier curves. A propensity score-matched analysis and a Cox regression model were used to adjust for potential confounders.
A total of 1,883 patients with SCLC met our criteria and were enrolled in the study. The LCSS and OS analyses revealed that patients who underwent LN dissection during surgery had longer survival times significantly than patients who did not. Similarly, patients who underwent more extensive LN dissection (≥4 LNs) had longer survival times than those who underwent less extensive LN dissection (1-3 LNs). However, no significant increase in survival time was found for patients who underwent the dissection of ≥12 LNs compared to those who underwent the dissection of 4-11 LNs. These results were confirmed in our propensity-matched and Cox regression analyses.
Our study revealed that patient survival after surgical resection for SCLC is associated with the number of dissected LNs, and the number of LNs for dissection ranges from 4 to 11 achieve the best survival outcome.
关于小细胞肺癌（SCLC）切除术中淋巴结（LN）清扫重要性的证据稀缺。本研究旨在探讨淋巴结清扫范围对SCLC患者生存的临床影响。
从监测、流行病学和最终结果（SEER）癌症登记处识别出2000年至2016年间接受原发性SCLC切除术的患者。通过X-Tile软件分析根据清扫的LN数量（0、1 - 3、4 - 11和≥12）对患者进行分层，并使用Kaplan-Meier曲线比较这些分层组之间的肺癌特异性生存（LCSS）和总生存（OS）。采用倾向评分匹配分析和Cox回归模型来调整潜在的混杂因素。
共有1883例SCLC患者符合我们的标准并纳入研究。LCSS和OS分析显示，手术中接受LN清扫的患者生存时间明显长于未接受清扫的患者。同样，接受更广泛LN清扫（≥4个LN）的患者生存时间比接受较少广泛LN清扫（1 - 3个LN）的患者更长。然而，与接受4 - 11个LN清扫的患者相比，接受≥12个LN清扫的患者生存时间没有显著增加。这些结果在我们的倾向匹配和Cox回归分析中得到证实。
我们的研究表明，SCLC手术切除后患者的生存与清扫的LN数量相关，清扫4至11个LN可实现最佳生存结果。
