Author of

• 15046

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  MINI 20 - Surgery (ID 137)

  • Event: WCLC 2015
  • Type: Mini Oral
  • Track: Treatment of Locoregional Disease – NSCLC
  • Presentations: 1
  • Moderators:G. Veronesi, R. Flores
  • Coordinates: 9/08/2015, 16:45 - 18:15, 201+203

  • 15049

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    MINI20.03 - The Survival Impact of Missed Lymph Node Metastasis in Surgically Resected Non-Small Cell Lung Cancer (NSCLC) (ID 2204)

    16:45 - 18:15  |  Author(s): C. Adair
    • Abstract
    • Presentation
    • Slides

    Background:
    Lymph node (LN) metastasis is an important prognostic factor for patients with surgically resected NSCLC. We have previously described the extent of missed N1 LN metastasis in a cohort of patients treated at metropolitan institutions. With long-term follow up, we now quantify the survival impact of missed LN metastasis.
    
    Methods:
    We conducted a prospective cohort study to retrieve intrapulmonary LNs from discarded NSCLC resection specimens after completion of routine pathology examination. Retrieved materials were histologically examined and classified as LNs with and without metastasis. Survival information was retrieved from institutional tumor registries. Survival distributions were plotted using the Kaplan-Meier method and evaluated with proportional hazards models controlling for gender, race, pathologic N-category, tumor size, margin status, and Charlson score.
    
    Results:
    We evaluated 111 patients who were 47% male with a median age of 66 years. Clinical characteristics are summarized in Table 1. Discarded LNs with metastasis were found after re-dissection in 25 (23%) patients. Patients with discarded LN metastasis had an increased risk of death (Figure 1) with an unadjusted hazard ratio (HR) of 2.0 (p-value=0.06) and an adjusted HR of 1.8 (p-value=0.23) compared to those with no discarded LNs with metastasis. When >2 discarded LNs with metastasis were found, patients had 4.8 (p-value=0.0002) times the hazard of death compared to those with no discarded LNs with metastasis (adjusted HR=4.4, p-value=0.0032).

    N(%)	No LN Metastasis	LN Metastasis	Total
    Bi-lobectomy	8	2	10
    	9%	8%
    Lobectomy	75	16	91
    	87%	64%
    Pneumonectomy	3	7	10
    	3%	28%
    N0	71	6	77
    	83%	24%
    N1	6	12	18
    	7%	48%
    N2	9	7	16
    	10%	28%
    T1	45	3	48
    	52%	12%
    T2	29	11	40
    	34%	44%
    T3	10	8	18
    	12%	32%
    T4	2	2	4
    	2%	8%
    Margin Negative	83	22	105
    	97%	88%
    Margin Positive	3	3	6
    	3%	12%
    Mean(SD)
    Charlson Score	1.8	1.8	1.8
    	1.6	1.7	1.6
    Tumor Size(cm)	3.2	5.0	3.6
    	1.8	2.1	2.0

    Figure 1
    
    
    
    Conclusion:
    The presence of metastasis in inadvertently discarded LNs in NSCLC resection specimens has significant implications for patients’ post-operative clinical course. Additional LN metastasis found on re-dissection was associated with reduced survival. A more rigorous protocol for gross dissection of lung resection specimens is needed, and should prove beneficial to patients’ long-term survival.
    
    

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