Impact of L4 lymph node dissection on long-term survival in left-side operable non-small-cell lung cancer: a propensity score matching study
- 1 June 2020
- journal article
- conference paper
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 57 (6), 1181-1188
- https://doi.org/10.1093/ejcts/ezaa008
Abstract
OBJECTIVES: We investigated the impact of level 4 (L4) lymph node dissection (LND) on overall survival (OS) in left-side resectable non-small-cell lung cancer (NSCLC), with the aim of guiding lymphadenectomy. METHODS: A total of 1929 patients with left-side NSCLC who underwent R0 resection between 2001 and 2014 were included in the study. The patients were divided into a group with L4 LND (L4 LND+) and a group without L4 LND (L4 LND-). Propensity score matching was applied to minimize selection bias. The Kaplan-Meier method and Cox proportional hazards model were used to assess the impact of L4 LND on OS. RESULTS: A total of 317 pairs were matched. Of the cohort of patients, 20.3% (391/1929) had L4 LND. Of these patients, 11.8% (46/391) presented with L4 lymph node metastasis. L4 lymph node metastasis was not associated with the primary tumour lobes (P=0.61). Before propensity score matching, the 5-year OS was comparable between the L4 LND+ and L4 LND- groups (69.0% vs 65.2%, P=0.091). However, after propensity score matching, the 5-year OS of the L4 LND+ group was much improved compared to that of the L4 LND- group (72.9% vs 62.3%, P=0.002) and L4 LND was an independent factor favouring OS (hazard ratio 0.678, 95% confidence interval 0.513-0.897; P=0.006). Subgroup analysis suggested that L4 LND was an independent factor favouring OS in left upper lobe tumours. CONCLUSIONS: In patients with left-side operable NSCLC, L4 lymph node metastasis was not rare and L4 LND should be routinely performed.Funding Information
- Science and Technology Planning Project (2013B021800147)
- Natural Science Foundation of Guangdong Province (2016A030313857, 2018A030313410)
- Guangdong Provincial Medical Scientific Funds (2016114134515565)
- National Natural Science Foundation of China (81501986)
This publication has 25 references indexed in Scilit:
- The incidence and distribution of mediastinal lymph node metastasis and its impact on survival in patients with non-small-cell lung cancers 3 cm or less: data from 2292 casesEuropean Journal of Cardio-Thoracic Surgery, 2019
- Incidence and Distribution of Lobe-Specific Mediastinal Lymph Node Metastasis in Non-small Cell Lung Cancer: Data from 4511 Resected CasesAnnals of Surgical Oncology, 2018
- Lobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non–Small Cell Lung Cancer: A Propensity Score Matching StudyJournal of Thoracic Oncology, 2016
- Complete Thoracic Mediastinal Lymphadenectomy Leads to a Higher Rate of Pathologically Proven N2 Disease in Patients With Non-Small Cell Lung CancerThe Annals of Thoracic Surgery, 2012
- Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non–small cell carcinoma: Results of the American College of Surgery Oncology Group Z0030 TrialThe Journal of Thoracic and Cardiovascular Surgery, 2011
- Morbidity, Survival, and Site of Recurrence After Mediastinal Lymph-Node Dissection Versus Systematic Sampling After Complete Resection for Non-Small Cell Lung CancerThe Annals of Thoracic Surgery, 2005
- Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer?European Journal of Cardio-Thoracic Surgery, 2005
- A randomized trial of systematic nodal dissection in resectable non-small cell lung cancerLung Cancer, 2002
- Effectiveness of Radical Systematic Mediastinal Lymphadenectomy in Patients With Resectable Non-Small Cell Lung CancerAnnals of Surgery, 1998
- Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancerThe Annals of Thoracic Surgery, 1995