Objective: This retrospective study was conducted to investigate the impact of more extended mediastinal lymphadenectomy on the outcome of lung cancer patients treated with R0 resection. Methods: During the investig...Objective: This retrospective study was conducted to investigate the impact of more extended mediastinal lymphadenectomy on the outcome of lung cancer patients treated with R0 resection. Methods: During the investigation period, 325 lung cancer cases were enlisted and 278 cases entered the analysis. The patients were divided into Control group (n=116) and Research group (n=162) according to the different extents of mediastinal lymph node clearance at different time periods. Three major parameters were retrospectively assessed to compare the quality of surgical care: extent of lymph node clearance, resection volume, and postoperative recovery process and common complications. Comparison of the outcome between two groups was carried out. Results: Research group showed a significant quality improvement of lymphadenectomy, such as more mediastinal node stations investigated (more than 3 N2 stations investigated: Research group, 90.7% vs. Control group, 55.2%; P=0.001) and more nodes collection (total nodes 26.1±10.0 vs. 19.1±8.3, P=0.000; N2 nodes 15.5±7.2 vs. 9.8±5.6, P=0.000). However, overall survival (OS) and disease-free survival (DFS) were not significantly different either between two groups (5-year OS: Control group, 56.4±4.6% vs. Research group, 62.6±4.3%; P=0.271) or between subgroups from stage I to IIIa. TNM stage and histology were significant factors associated with OS and DFS in multivariate analysis; extent of mediastinal lymphadenectomy was not associated with OS or DFS. Conclusions: More radical mediastinal lymphadenectomy may not lead to an improved oncological outcome for lung cancer treated with R0 resection.展开更多
Objective: Survival benefit of adjuvant chemotherapy(AC) of patients with intrapulmonary lymph node(IPLN)metastasis(level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes wer...Objective: Survival benefit of adjuvant chemotherapy(AC) of patients with intrapulmonary lymph node(IPLN)metastasis(level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.Methods: First,155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated.Patients received systematic dissection of N2 and N1 nodes.For patients with IPLN metastasis,survival outcomes were compared between those receiving AC and those not receiving AC.Results: In this group,112 cases(72.3%) had IPLN metastasis and 55 cases(35.5%) had N1 involvement limited to level 13-14 without further disease spread to higher levels.Patients with IPLN involvement had a better prognosis than that of patients with hilar-interlobar involvement.For the intrapulmonary N1 group(level 12-14-positive,level 10-11-negative or unknown,n=112),no survival benefit was found between the AC group and nonAC group [5-year overall survival(OS): 54.6±1.6 vs.50.4±2.4 months,P=0.177].However,76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports(level 12-14-positive,level 10-11 both negative),oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup(5-year OS: 57.3±1.5 vs.47.1±3.2 months,P=0.002).Conclusions: Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.展开更多
基金supported partially by the Strategic Priority Research Program of the Chinese Academy of Sciences (XDA06020101)the National Natural Science Foundation (No. 81350028)+1 种基金the National High Technology Research and Development Program of China (863 Program, No. 2012AA02A502)the Beijing Municipal Science & Technology Commission (No. Z111107067311018)
文摘Objective: This retrospective study was conducted to investigate the impact of more extended mediastinal lymphadenectomy on the outcome of lung cancer patients treated with R0 resection. Methods: During the investigation period, 325 lung cancer cases were enlisted and 278 cases entered the analysis. The patients were divided into Control group (n=116) and Research group (n=162) according to the different extents of mediastinal lymph node clearance at different time periods. Three major parameters were retrospectively assessed to compare the quality of surgical care: extent of lymph node clearance, resection volume, and postoperative recovery process and common complications. Comparison of the outcome between two groups was carried out. Results: Research group showed a significant quality improvement of lymphadenectomy, such as more mediastinal node stations investigated (more than 3 N2 stations investigated: Research group, 90.7% vs. Control group, 55.2%; P=0.001) and more nodes collection (total nodes 26.1±10.0 vs. 19.1±8.3, P=0.000; N2 nodes 15.5±7.2 vs. 9.8±5.6, P=0.000). However, overall survival (OS) and disease-free survival (DFS) were not significantly different either between two groups (5-year OS: Control group, 56.4±4.6% vs. Research group, 62.6±4.3%; P=0.271) or between subgroups from stage I to IIIa. TNM stage and histology were significant factors associated with OS and DFS in multivariate analysis; extent of mediastinal lymphadenectomy was not associated with OS or DFS. Conclusions: More radical mediastinal lymphadenectomy may not lead to an improved oncological outcome for lung cancer treated with R0 resection.
基金supported in part by National Key R&D Program of China(No.2018YFC0910700)the Beijing Municipal Administration of Hospitals'Youth Programme(No.QML20171103)+2 种基金the Special Fund of Beijing Municipal Administration of Hospitals Clinical Medicine Development(No.XMLX201841)the Beijing Municipal Science&Technology Commission(No.Z161100000516063)Beijing Human Resources and Social Security Bureau(Beijing Millions of Talents Project,2018A05)
文摘Objective: Survival benefit of adjuvant chemotherapy(AC) of patients with intrapulmonary lymph node(IPLN)metastasis(level 12-14) needs investigation.We evaluated the impact of AC on patients whose metastatic nodes were limited to intrapulmonary levels after systematic dissection of N1 nodes.Methods: First,155 consective cases of lung cancer confirmed as pathologic N1 were collected and evaluated.Patients received systematic dissection of N2 and N1 nodes.For patients with IPLN metastasis,survival outcomes were compared between those receiving AC and those not receiving AC.Results: In this group,112 cases(72.3%) had IPLN metastasis and 55 cases(35.5%) had N1 involvement limited to level 13-14 without further disease spread to higher levels.Patients with IPLN involvement had a better prognosis than that of patients with hilar-interlobar involvement.For the intrapulmonary N1 group(level 12-14-positive,level 10-11-negative or unknown,n=112),no survival benefit was found between the AC group and nonAC group [5-year overall survival(OS): 54.6±1.6 vs.50.4±2.4 months,P=0.177].However,76 of 112 cases for whom harvesting of level-10 and level-11 nodes was done did not show cancer involvement in pathology reports(level 12-14-positive,level 10-11 both negative),oncologic outcome was better for patients receiving AC than those not receiving AC in this subgroup(5-year OS: 57.3±1.5 vs.47.1±3.2 months,P=0.002).Conclusions: Oncologic outcome may be improved by AC for patients with involvement of N1 nodes limited to intrapulmonary levels after complete examination of N1 nodes.