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Quantification of Tumor Cell Adhesion in Lymph Node Cryosections
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Commission on Cancer Standards for Lymph Node Sampling and Oncologic Outcomes After Lung Resection.

Benjamin J Resio1, Kay See Tan1, Matthew Skovgard1

  • 1Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.

The Annals of Thoracic Surgery
|September 19, 2024
PubMed
Summary
This summary is machine-generated.

New lung cancer guidelines for lymph node sampling (3 mediastinal, 1 hilar) increased upstaging and complications but improved survival only in stage III patients. Further research is needed for optimal strategies.

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Pulmonary Medicine

Background:

  • The Commission on Cancer updated lung cancer resection standards, recommending sampling 3 mediastinal (N2) and 1 hilar (N1) lymph node stations.
  • The impact of this guideline-concordant lymph node sampling on patient outcomes remains under investigation.

Purpose of the Study:

  • To evaluate the association between guideline-concordant lymph node sampling (3 N2, 1 N1) and oncologic outcomes in lung cancer resections.
  • To assess the relationship between guideline concordance and nodal upstaging, complications, adjuvant therapy, recurrence, and survival.

Main Methods:

  • A prospective institutional database was queried for clinical stage I-III lung resections performed prior to guideline implementation.
  • Multivariable models were used to analyze outcomes, stratified by clinical stage, comparing guideline-concordant (3 N2, 1 N1) to nonconcordant sampling.

Main Results:

  • Of 9289 resections, 33% were guideline concordant. Concordant sampling was associated with higher rates of nodal upstaging (21% vs 13%) and in-hospital complications (34% vs 27%).
  • Adjuvant systemic therapy administration was similar between groups. No significant improvement in locoregional or distant recurrence was observed across stages.
  • Overall survival was similar for clinical stages I and II, but significantly improved for guideline-concordant clinical stage III patients (HR, 0.85).

Conclusions:

  • Guideline-concordant lymph node sampling (3 N2, 1 N1) increases nodal upstaging and complications but does not reduce recurrence or mortality in clinical stages I and II lung cancer.
  • Improved survival was observed in guideline-concordant clinical stage III patients, suggesting a potential benefit in advanced disease.
  • Further research is warranted to determine the optimal lymph node sampling strategy for diverse lung cancer patient populations.