Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules

Raja M. Flores, Daniel Nicastri, Thomas Bauer, Ralph Aye, Shahriyour Andaz, Leslie Kohman, Barry Sheppard, William Mayfield, Richard Thurer, Robert Korst, Michaela Straznicka, Fred Grannis, Harvey Pass, Cliff Connery, Rowena Yip, James P. Smith, David F. Yankelevitz, Claudia I. Henschke, Nasser K. Altorki

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective: To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. Background: Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. Methods: Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. Results: The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4-3.8), centrally located tumor (HR 2.5, 95% CI 1.2-5.2), tumor size 21 to 30 mm (HR 2.7, 95% CI 1.2-6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4-6.1). For the 346 patients with MLNR, tumor size was 20 mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). Conclusions: It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.

Original languageEnglish (US)
Pages (from-to)1025-1033
Number of pages9
JournalAnnals of surgery
Volume265
Issue number5
DOIs
StatePublished - May 1 2017

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Keywords

  • clinical stage IA
  • lung cancer
  • mediastinal lymph node resection
  • nonsmall cell
  • solid nodule
  • subsolid nodule

ASJC Scopus subject areas

  • Surgery

Cite this

Flores, R. M., Nicastri, D., Bauer, T., Aye, R., Andaz, S., Kohman, L., Sheppard, B., Mayfield, W., Thurer, R., Korst, R., Straznicka, M., Grannis, F., Pass, H., Connery, C., Yip, R., Smith, J. P., Yankelevitz, D. F., Henschke, C. I., & Altorki, N. K. (2017). Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules. Annals of surgery, 265(5), 1025-1033. https://doi.org/10.1097/SLA.0000000000001802