Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

TY - JOUR

T1 - Computed Tomography Screening for Lung Cancer

T2 - Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

AU - Flores, Raja M.

AU - Nicastri, Daniel

AU - Bauer, Thomas

AU - Aye, Ralph

AU - Andaz, Shahriyour

AU - Kohman, Leslie

AU - Sheppard, Barry

AU - Mayfield, William

AU - Thurer, Richard

AU - Korst, Robert

AU - Straznicka, Michaela

AU - Grannis, Fred

AU - Pass, Harvey

AU - Connery, Cliff

AU - Yip, Rowena

AU - Smith, James P.

AU - Yankelevitz, David F.

AU - Henschke, Claudia I.

AU - Altorki, Nasser K.

N1 - Publisher Copyright: © Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Objective: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. Background: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. Methods: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. Results: The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4-3.8), centrally located tumor (HR 2.5, 95% CI 1.2-5.2), tumor size 21 to 30 mm (HR 2.7, 95% CI 1.2-6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4-6.1). For the 346 patients with MLNR, tumor size was 20 mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). Conclusions: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.

AB - Objective: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. Background: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. Methods: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. Results: The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4-3.8), centrally located tumor (HR 2.5, 95% CI 1.2-5.2), tumor size 21 to 30 mm (HR 2.7, 95% CI 1.2-6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4-6.1). For the 346 patients with MLNR, tumor size was 20 mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). Conclusions: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.

KW - clinical stage IA

KW - lung cancer

KW - mediastinal lymph node resection

KW - nonsmall cell

KW - solid nodule

KW - subsolid nodule

UR - https://www.scopus.com/pages/publications/84970027861

U2 - 10.1097/SLA.0000000000001802

DO - 10.1097/SLA.0000000000001802

M3 - Article

C2 - 27232256

SN - 0003-4932

VL - 265

SP - 1025

EP - 1033

JO - Annals of surgery

JF - Annals of surgery

IS - 5

ER -