Lymph node collection kit can improve long-term survival after lung cancer surgery

lung cancer

Long CA seen on CXR. Credit: James Heilman, MD / Wikipedia

According to a study published in the Journal of Thoracic Oncology Clinical and Research Reports. The journal is published by the International Association for the Study of Lung Cancer.

Surgical resection is the main curative treatment for non-small cell lung cancer (NSCLC). With successful implementation of lung cancer screening programs, the proportion of patients with NSCLC undergoing surgery is likely to increase significantly.

“However, poor surgical quality reduces the survival benefit of curative surgery and suboptimal pathological nodal evaluation is the most common quality deficiency of NSCLC surgery. The problem is global and common in settings with different characteristics,” said study co-author Matthew Smeltzer. Ph.D., University of Memphis School of Public Health, Memphis, Tenn.

The IASLC has proposed a revision of the residual disease (R factor) classification from complete (R0), microscopic incomplete (R1) and grossly incomplete (R2) to R0, ‘R-uncertain’, R1 and R2. The adverse prognostic impact of R uncertainty has been independently validated, with the majority caused by poor evaluation of the nodal points.

“We have previously shown a longer survival after that surgical resection with a lymph node sample collection kit published in the Journal of Thoracic Oncology in February, and now evaluate the R-factor redistribution as the mechanism of its survival benefit, “said Dr. Smeltzer.

The kit includes 12 anatomically pre-labeled sample containers and a checklist to indicate that certain lymph node stations should be examined.

“We designed it to improve intraoperative lymph node retrieval, compliant with evidence-based guidelines, the safe transfer of lymph node samples between surgery and pathology teams, and the accurate identification of the anatomical origin of lymph node samples to enable thorough and accurate pathological evaluation. , “he said.

An ongoing NIH-funded population-based dissemination and implementation project (2 R01 CA172253), the Mid-South Quality of Surgical Resection (MSQSR) project includes 15 hospitals in East Arkansas, North and Central Mississippi, and West -Tennessee. The lead investigator, Ray Osarogiagbon, MD, of Baptist Memorial Health Care Corporation in Memphis, Tennessee, is a member of the IASLC’s Staging and Prognostic Factors Committee. In this particular analysis, Dr. Smeltzer and his fellow researchers 3,505 lung resections between 2009-2019 from the MSQSR cohort.

Of the 3,505 resections, 34% were R0, 60% R-uncertain and 6% R1 / 2. The R0 rate increased from 9% in 2009 to 56% in 2019. Kit cases were 66% R0 and 29% R-uncertain , compared with 14% R0 and 79% R-uncertain in non-kit cases (p

Kit cases also had lower rates of non-examination of lymph nodes (i.e., pNX), 1% vs. 14% (p

The adjusted hazard ratio (aHR) for cases with kit versus cases without kit was 0.75 ([CI 0.66-0.85], p

Dr. Smeltzer pointed out that a more carefully controlled study is planned to confirm these results.

“Ultimately, the main limitation of this study is that it was not a randomized controlled trial. We propose to conduct such a study to further evaluate the lymph node kit,” he said.

Accurate staging of lung cancer depends on a high-quality node study

More information:
Matthew P. Smeltzer et al, Impact of a Lymph Node Sample Collection Kit on the Distribution and Survival Implications of the Proposed Revised Classification of Lung Cancer Residual Diseases: A Tendency Analysis., JTO clinical and research reports (2021). DOI: 10.1016 / j.jtocrr.2021.100161

Provided by International Association for the Study of Lung Cancer

Quote: Lymph Node Collection Kit May Improve Long-Term Survival After Lung Cancer Surgery (2021, March 23) Retrieved May 2, 2021 from – survival.html

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