The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management
Purpose: To identify the incidence, preoperative risk factors, and prognosis associated with pathologically positive lymph node (pN+) in patients undergoing a sub-lobar resection (SLR).Methods: This is a retrospective study using the National Cancer Database (NCDB) from 2004 to 2014 analyzing SLR ex...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-05-01
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| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.00417/full |
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DOAJ |
| language |
English |
| format |
Article |
| sources |
DOAJ |
| author |
John M. Varlotto John M. Varlotto Isabel Emmerick Isabel Emmerick Rick Voland Malcom M. DeCamp John C. Flickinger Debra J. Maddox Christine Herbert Molly Griffin Paul Rava Paul Rava Thomas J. Fitzgerald Thomas J. Fitzgerald Paulo Oliveira Paulo Oliveira Jennifer Baima Rahul Sood William Walsh William Walsh Lacey J. McIntosh Lacey J. McIntosh Feiran Lou Feiran Lou Mark Maxfield Mark Maxfield Negar Rassaei Karl Uy Karl Uy |
| spellingShingle |
John M. Varlotto John M. Varlotto Isabel Emmerick Isabel Emmerick Rick Voland Malcom M. DeCamp John C. Flickinger Debra J. Maddox Christine Herbert Molly Griffin Paul Rava Paul Rava Thomas J. Fitzgerald Thomas J. Fitzgerald Paulo Oliveira Paulo Oliveira Jennifer Baima Rahul Sood William Walsh William Walsh Lacey J. McIntosh Lacey J. McIntosh Feiran Lou Feiran Lou Mark Maxfield Mark Maxfield Negar Rassaei Karl Uy Karl Uy The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management Frontiers in Oncology sub-lobar resection (SLR) radiation node positive incidence lung cancer |
| author_facet |
John M. Varlotto John M. Varlotto Isabel Emmerick Isabel Emmerick Rick Voland Malcom M. DeCamp John C. Flickinger Debra J. Maddox Christine Herbert Molly Griffin Paul Rava Paul Rava Thomas J. Fitzgerald Thomas J. Fitzgerald Paulo Oliveira Paulo Oliveira Jennifer Baima Rahul Sood William Walsh William Walsh Lacey J. McIntosh Lacey J. McIntosh Feiran Lou Feiran Lou Mark Maxfield Mark Maxfield Negar Rassaei Karl Uy Karl Uy |
| author_sort |
John M. Varlotto |
| title |
The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management |
| title_short |
The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management |
| title_full |
The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management |
| title_fullStr |
The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management |
| title_full_unstemmed |
The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its Management |
| title_sort |
incidence of node-positive non-small-cell lung cancer undergoing sublobar resection and the role of radiation in its management |
| publisher |
Frontiers Media S.A. |
| series |
Frontiers in Oncology |
| issn |
2234-943X |
| publishDate |
2020-05-01 |
| description |
Purpose: To identify the incidence, preoperative risk factors, and prognosis associated with pathologically positive lymph node (pN+) in patients undergoing a sub-lobar resection (SLR).Methods: This is a retrospective study using the National Cancer Database (NCDB) from 2004 to 2014 analyzing SLR excluding those with any preoperative chemotherapy and/or radiation, follow-up <3 months, stage IV disease, or >1 tumor nodule. Multivariable modeling (MVA) was used to determine factors associated with overall survival (OS). Propensity score matching (PSM) was used to determine preoperative risk factors for pN+ in patients having at least one node examined to assess radiation's effect on OS in those patients with pN+ and to determine whether SLR was associated with inferior OS as compared to lobectomy for each nodal stage.Results: A total of 40,202 patients underwent SLR, but only 58.3% had one lymph node examined. Then, 2,615 individuals had pN+ which decreased progressively from 15.1% in 2004 to 8.9% in 2014 (N1, from 6.3 to 3.0%, and N2, from 8.4 to 5.9%). A lower risk of pN+ was noted for squamous cell carcinomas, bronchioloalveolar adenocarcinoma (BAC), adenocarcinomas, and right upper lobe locations. In the pN+ group, OS was worse without chemotherapy or radiation. Radiation was associated with a strong trend for OS in the entire pN+ group (p = 0.0647) which was largely due to the effects on those having N2 disease (p = 0.009) or R1 resections (p = 0.03), but not N1 involvement (p = 0.87). PSM noted that SLR was associated with an inferior OS as compared to lobectomy by nodal stage in the overall patient population and even for those with tumors <2 cm.Conclusion: pN+ incidence in SLRs has decreased over time. SLR was associated with inferior OS as compared to lobectomy by nodal stage. Radiation appears to improve the OS in patients undergoing SLR with pN+, especially in those with N2 nodal involvement and/or positive margins. |
| topic |
sub-lobar resection (SLR) radiation node positive incidence lung cancer |
| url |
https://www.frontiersin.org/article/10.3389/fonc.2020.00417/full |
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doaj-6b38bb933d0947619127470cbce1a34c2020-11-25T02:56:48ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-05-011010.3389/fonc.2020.00417525356The Incidence of Node-Positive Non-small-Cell Lung Cancer Undergoing Sublobar Resection and the Role of Radiation in Its ManagementJohn M. Varlotto0John M. Varlotto1Isabel Emmerick2Isabel Emmerick3Rick Voland4Malcom M. DeCamp5John C. Flickinger6Debra J. Maddox7Christine Herbert8Molly Griffin9Paul Rava10Paul Rava11Thomas J. Fitzgerald12Thomas J. Fitzgerald13Paulo Oliveira14Paulo Oliveira15Jennifer Baima16Rahul Sood17William Walsh18William Walsh19Lacey J. McIntosh20Lacey J. McIntosh21Feiran Lou22Feiran Lou23Mark Maxfield24Mark Maxfield25Negar Rassaei26Karl Uy27Karl Uy28Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDivision of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United StatesSchool of Nursing, University of Wisconsin, Madison, WI, United StatesDivision of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United StatesDepartment of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, United StatesDepartment of Medical Oncology, University of Massachusetts Medical Center, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDepartment of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDepartment of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDivision of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts, Worcester, MA, United StatesDepartment of Orthopedics and Rehabilitation, University of Massachusetts Medical Center, Worcester, MA, United StatesDivision of Pulmonary, Allergy and Critical Care Medicine, University of Massachusetts, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDepartment of Medical Oncology, University of Massachusetts Medical Center, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United States0Department of Radiology, University of Massachusetts, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDivision of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDivision of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United States1Department of Pathology, Penn State Hershey Medical Center, Hershey, PA, United StatesUniversity of Massachusetts Medical School, Worcester, MA, United StatesDivision of Thoracic Surgery, University of Massachusetts Medical Center, Worcester, MA, United StatesPurpose: To identify the incidence, preoperative risk factors, and prognosis associated with pathologically positive lymph node (pN+) in patients undergoing a sub-lobar resection (SLR).Methods: This is a retrospective study using the National Cancer Database (NCDB) from 2004 to 2014 analyzing SLR excluding those with any preoperative chemotherapy and/or radiation, follow-up <3 months, stage IV disease, or >1 tumor nodule. Multivariable modeling (MVA) was used to determine factors associated with overall survival (OS). Propensity score matching (PSM) was used to determine preoperative risk factors for pN+ in patients having at least one node examined to assess radiation's effect on OS in those patients with pN+ and to determine whether SLR was associated with inferior OS as compared to lobectomy for each nodal stage.Results: A total of 40,202 patients underwent SLR, but only 58.3% had one lymph node examined. Then, 2,615 individuals had pN+ which decreased progressively from 15.1% in 2004 to 8.9% in 2014 (N1, from 6.3 to 3.0%, and N2, from 8.4 to 5.9%). A lower risk of pN+ was noted for squamous cell carcinomas, bronchioloalveolar adenocarcinoma (BAC), adenocarcinomas, and right upper lobe locations. In the pN+ group, OS was worse without chemotherapy or radiation. Radiation was associated with a strong trend for OS in the entire pN+ group (p = 0.0647) which was largely due to the effects on those having N2 disease (p = 0.009) or R1 resections (p = 0.03), but not N1 involvement (p = 0.87). PSM noted that SLR was associated with an inferior OS as compared to lobectomy by nodal stage in the overall patient population and even for those with tumors <2 cm.Conclusion: pN+ incidence in SLRs has decreased over time. SLR was associated with inferior OS as compared to lobectomy by nodal stage. Radiation appears to improve the OS in patients undergoing SLR with pN+, especially in those with N2 nodal involvement and/or positive margins.https://www.frontiersin.org/article/10.3389/fonc.2020.00417/fullsub-lobar resection (SLR)radiationnode positiveincidencelung cancer |