Association of Lymph Node Sampling and Clinical Volume in Lobectomy for Non-Small Cell Lung Cancer

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Cancer Research

Background:

• The American College of Surgeons Commission on Cancer previously used sampling of ≥10 lymph nodes during lobectomy for non-small cell lung cancer (NSCLC) as a quality metric.
• This study investigates guideline adherence and its relationship to hospital lobectomy volume within The Society of Thoracic Surgeons General Thoracic Surgery Database.

Purpose of the Study:

• To determine adherence to the ≥10 lymph node sampling guideline during NSCLC lobectomy.
• To assess the relationship between hospital lobectomy volume and lymph node yield.

Main Methods:

• Data from 305 centers and 43,597 patients undergoing elective NSCLC lobectomy (2012-2019) were analyzed.
• Centers were stratified into tertiles based on annual lobectomy volume (low, medium, high).
• Multivariable logistic regression identified factors associated with achieving an average nodal harvest of ≥10 nodes per lobectomy.

Main Results:

• Higher hospital volume was significantly associated with increased lymph node yield (P < .001).
• Medium-volume centers had an odds ratio of 2.94 (CI, 1.57-5.50) and high-volume centers had an odds ratio of 3.82 (CI, 1.95-7.46) for achieving ≥10 lymph nodes per lobectomy.
• Despite this association, 25% of high-volume centers averaged fewer than 10 lymph nodes per lobectomy.

Conclusions:

• Increased lymph node harvest during NSCLC lobectomy is linked to higher center volume.
• Suboptimal lymph node yield in a significant portion of even high-volume centers may lead to understaging of NSCLC.
• Accurate staging is critical for appropriate adjuvant therapy selection and improving long-term patient survival.