Spanish Lung Cancer Group SCAT trial: surgical audit to lymph node assessment based on IASLC recommendations

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• The Spanish Customized Adjuvant Therapy (SCAT) trial investigated individualized adjuvant therapy for resected non-small cell lung cancer (NSCLC) with clinical N0, incidental pN1, or N2 disease.
• This study focused on evaluating the quality of lymphadenectomy in these patients according to International Association for the Study of Lung Cancer (IASLC) guidelines.

Purpose of the Study:

• To assess the adherence to IASLC lymphadenectomy recommendations in NSCLC surgery.
• To analyze the impact of lymph node assessment quality and involvement on patient survival.

Main Methods:

• Retrospective analysis of prospectively collected data from 451 NSCLC patients with available lymphadenectomy information.
• Evaluation of tumor characteristics, resection type, postoperative morbidity, and lymph node dissection (LND) quality.
• Survival analysis using Kaplan-Meier curves and regression models to identify prognostic factors.

Main Results:

• A significant proportion of surgeries did not meet IASLC recommendations: regions 7, 10, and 11 were unassessed in 33.7%, 17.7%, and 49.9% of cases, respectively.
• Inadequate lymph node assessment was common: <3 regions biopsied in 21.1% and <6 nodes assessed in 19.6% of patients.
• Lymph node status significantly impacted survival: 5-year overall survival was 61.7% for N1, 51.5% for N2, and 42.3% for N1+N2 disease (P<0.01). Both the number of nodes resected and involved were significant prognostic factors.

Conclusions:

• Adherence to IASLC surgical recommendations for lymphadenectomy in NSCLC is suboptimal.
• The extent of hilar and mediastinal lymph node assessment and tumor involvement critically influence patient prognosis.
• Postoperative mortality could not be assessed due to trial design limitations.