Mediastinal lymph node dissection in older adults with radiologically pure-solid stage I lung cancer

To clarify the prognostic impact and associated complications of mediastinal lymph node dissection (MLND) in older adults with radiologically pure solid clinical stage I non-small cell lung cancer (NSCLC), using data from a nationwide surgical database in Japan (n = 18,973).

Of 2075 older adults (≥75 years of age), who underwent complete anatomical resection for clinical stage I NSCLC and registered in the database, data from 1313 with pure-solid tumours on preoperative computed tomography were included. To compare survival and the incidence of postoperative complications, patients were classified into two groups according to the extent of lymph node dissection: MLND; and non-MLND. An inverse probability of treatment weighting method with propensity scoring was used to reduce selection bias. After matching, 1162 patients were analysed for overall survival (OS), and 1153 for disease-free survival (DFS) and cumulative incidence of recurrence (CIR).

Before matching, the MLND group exhibited significantly better DFS and OS than the non-MLND group (P = .030 and P = .013, respectively). Multivariable analysis revealed that MLND did not affect the incidence of postoperative complications (≥ grade III). After matching, there were no significant differences between the two groups in terms of DFS, OS, or CIR (P = .536, P = .409, and P = .933, respectively).

MLND did not yield a survival benefit in older adults (≥75 years of age) even with radiologically pure-solid clinical stage I NSCLC. Anatomical pulmonary resection without MLND may be an alternative treatment option for these patients.