Open AccessImpact of visceral pleural invasion on the association of extent of lymphadenectomy and survival in stage I non‐small cell lung cancer
Author(s) -
Wo Yang,
Zhao Yandong,
Qiu Tong,
Li Shicheng,
Wang Yuanyong,
Lu Tong,
Qin Yi,
Song Guisong,
Miao Shuncheng,
Sun Xiao,
Liu Ao,
Kong Dezhi,
Dong Yanting,
Leng Xiaoliang,
Du Wenxing,
Jiao Wenjie
Publication year - 2019
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.1990
Subject(s) - medicine , lymphadenectomy , dissection (medical) , stage (stratigraphy) , proportional hazards model , hazard ratio , propensity score matching , lung cancer , lymph node , surveillance, epidemiology, and end results , overall survival , survival analysis , cancer , surgery , survival rate , cancer registry , confidence interval , biology , paleontology
Visceral pleural invasion ( VPI ) has been identified as an adverse prognostic factor for non‐small cell lung cancer ( NSCLC ). Accurate nodal staging for NSCLC correlates with improved survival, but it is unclear whether tumors with VPI require a more extensive lymph nodes ( LN s) dissection to optimize survival. We aimed to evaluate the impact of VPI status on the optimal extent of LN s dissection in stage I NSCLC , using the Surveillance, Epidemiology, and End Results ( SEER ) database. We identified 9297 surgically treated T1‐2aN0M0 NSCLC patients with at least one examined LN s. Propensity score matching was conducted to balance the baseline clinicopathologic characteristics between the VPI group and non‐ VPI group. Log‐rank tests along with Cox proportional hazards regression methods were performed to evaluate the impact of extent of LN s dissection on survival. VPI was correlated with a significant worse survival, but there was no significant difference in survival rate between PL 1 and PL 2. Patients who underwent sublobectomy had slightly decreased survival than those who underwent lobectomy. Pathologic LN s examination was significantly correlated with survival. Examination of 7‐8 LN s and 14‐16 LN s conferred the lowest hazard ratio for T1‐sized/non‐ VPI tumors (stage IA ) and T1‐sized/ VPI tumors (stage IB ), respectively. The optimal extent of LN s dissection varied by VPI status, with T1‐sized/ VPI tumors (stage IB ) requiring a more extensive LN s dissection than T1‐sized/non‐ VPI tumors (stage IA ). These results might provide guidelines for surgical procedure in early stage NSCLC .