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Hirotoshi Dosaka-Akita



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    MA23 - Early Stage Lung Cancer: Present and Future (ID 926)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 10:30 - 12:00, Room 105
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      MA23.11 - Lobe-Specific Nodal Dissection for Clinical Stage I and II Non-Small Cell Lung Cancer: Japanese Multi-Institutional Retrospective Study (ID 13741)

      11:40 - 11:45  |  Author(s): Hirotoshi Dosaka-Akita

      • Abstract
      • Presentation
      • Slides

      Background

      Systematic nodal dissection (SND) is an international standard of lymph node dissection for non-small cell lung cancer (NSCLC). Recently, lobe-specific patterns of mediastinal lymph node metastases have been recognized, and lobe-specific nodal dissection (LSD) has been proposed for early-stage NSCLC. The purpose of this study was to assess the surgical outcomes according to the extent of mediastinal lymph node dissection for patients with NSCLC by using a nationwide registry database.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      From among 11,663 patients in a Japanese lung cancer registry study for 2004, 5392 patients with clinical stage (c-stage) I or II NSCLC that was completely resected by lobectomy and either SND or LSD were enrolled. Patients who received preoperative therapy or had middle lobe tumor were excluded. In the LSD group, inferior mediastinal (subcarinal) nodes were not dissected for upper lobe tumors, and superior mediastinal nodes were not dissected for lower lobe tumors. To reduce the selection bias, an inverse probability of treatment weighting (IPTW) method using a propensity score was implemented.

      4c3880bb027f159e801041b1021e88e8 Result

      LSD and SND were performed in 1,268 (23.5%) and 4,124 (76.5%) patients, respectively. LSD group included more c-IA and upper lobe tumors relative to SND group, although there was no significant differences in age and preoperative comorbidity. There was no significant difference in postoperative morbidity and mortality between 2 groups. Extended pathological N2 disease outside LSD area was found in 3.2% of the SND group, but recurrences were not different between 2 groups (all recurrences: 22.0% in LSD, 26.9% in SND; local recurrence: 6.1% in LSD, 7.7% in SND; p=0.788). The 5-year overall survival (OS) was 81.5% in LSD and SND in 75.9%. An IPTW–adjusted Cox model showed that LSD did not have a negative prognostic impact and instead was associated with favorable survival (hazard ratio: 0.68, 95% confidence interval: 0.60-0.77).

      8eea62084ca7e541d918e823422bd82e Conclusion

      This retrospective registry study suggested that LSD is an alternative to SND for selected patients with c-stage I or II NSCLC. Future prospective studies are warranted to determine whether LSD is applicable and provides clinical benefit for the general population of patients with cstage I or II NSCLC.

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