Spanish Lung Cancer Group SCAT trial: surgical audit to lymph node assessment based on IASLC recommendations
Por:
Sarceda, J, Nadal, S, Poce, R, de Castro, P, Balsalobre, R, Cuesta, J, Flor, R, Ferrer, J, Algar, F, Garcia, A, Jimenez, M, Sales-Badia, J, Pereira, E, Massuti, B, Provencio, M and Trancho, F
Publicada:
1 abr 2021
Resumen:
Background: The Spanish Customized Adjuvant Therapy (SCAT) trial assessed the role of individualized adjuvant therapy in clinical N0 incidental pN1 and/or N2 non-small cell lung cancer (NSCLC) completely resected. We assessed surgical topics with an in-depth analysis of quality of lymphadenectomy based on International Association for the Study of Lung Cancer (IASLC) recommendations.
Methods: Patients with information about lymphadenectomy available were included (N=451). Prospectively collected data about tumor, type of resection, and postoperative morbidity and quality of lymph node dissection (LND) were retrospectively evaluated. Role of lymph node assessment on survival was analyzed using Kaplan-Meier curves, using regression models to identify prognostic factors.
Results: In 33.7%, 17.7% and 49.9% of cases, regions 7, 10 and 11 respectively were not assessed. In 21.1% of patients, less than three lymph node regions were biopsied, while in 19.6% of patients less than six lymph nodes were assessed. In 53,4% of patients only one N1 region was evaluated. From patients with positive N2, 8.9% had no N1 regions biopsied. Twenty-nine percent of patients with at least one N2 lymph node resected shown the highest region involved. Thirty-day postoperative mortality was unknown. Five-year overall survival (OS) was 61.7% (95% CI: 55.4-67.4%), 51.5% (95% CI: 39.2-62.4%) and 42.3% (95% CI: 32.1-52.2%) for patients with N1, N2 and N1+N2 disease, respectively (P<0.01). Both number of lymph nodes resected and number of lymph nodes involved by tumor were significantly related to prognosis.
Conclusions: IASLC recommendations for surgical resections were not followed in a high proportion of surgical procedures. Hilar and mediastinal lymph node assessment and involvement showed to impact prognosis. Surgical issues such as postoperative mortality could not be evaluated owing to trial design.
Filiaciones:
Sarceda, J:
Hosp Clin San Carlos, Dept Thorac Surg, Madrid, Spain
:
Hosp Univ Alicante, Dept Thorac Surg, Alicante, Spain
Poce, R:
Hosp Univ Malaga, Dept Thorac Surg, Malaga, Spain
de Castro, P:
Hosp Badalona Germans Trias & Pujol, Dept Thorac Surg, Barcelona, Spain
Balsalobre, R:
Hosp Univ Princesa, Dept Thorac Surg, Madrid, Spain
Cuesta, J:
Inst Valenciano Oncol, Dept Thorac Surg, Valencia, Spain
Flor, R:
Hosp Univ Miguel Servet, Dept Thorac Surg, IIS Aragon, Zaragoza, Spain
Ferrer, J:
Hosp Univ Cruces, Dept Thorac Surg, Bilbao, Spain
Algar, F:
Hosp Univ Reina Sofia Cordoba, Dept Thorac Surg, Cordoba, Spain
Garcia, A:
Hosp Univ 12 Octubre, Dept Thorac Surg, Madrid, Spain
Jimenez, M:
Hosp Univ Salamanca, Dept Thorac Surg, Salamanca, Spain
Sales-Badia, J:
Hosp Univ Fe, Dept Thorac Surg, Valencia, Spain
Pereira, E:
Spanish Lung Canc Grp, Barcelona, Spain
:
Hosp Univ Alicante, Dept Med Oncol, Alicante, Spain
Provencio, M:
Hosp Univ Puerta Hierro Majadahonda, Dept Oncol, Madrid, Spain
Trancho, F:
Hosp Clin San Carlos, Dept Thorac Surg, Madrid, Spain
gold, Green Published
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