title: A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer.
abstract: OBJECTIVE
  We conducted a randomized trial to investigate whether systematic nodal dissection (SND) is superior to mediastinal lymph nodal sampling (MLS) in surgical treatment of non-small cell lung cancer (NSCLC).
  
  
  METHODS
  The patients resectable clinical Stage I-IIIA NSCLC were randomly assigned to lung resection combined with SND or lung resection combined with MLS. After postoperative pathological re-staging, eligible cases were followed up until 30 November 2000. The Kaplan-Meier method was used for survival analysis. COX proportional hazards model was used for prognostic analysis.
  
  
  RESULTS
  Of the 532 patients who were enrolled in the study, 268 patients were assigned to lung resection combined with SND and 264 were assigned to lung resection combined with MLS. After surgical restaging only 471 cases were eligible for follow-up. The median survival was 59 months in the group given SND and 34 months in the group given MLS (P=0.0000 by the log rank test). There was significant difference in survival in Stage I (5-year survival 82.16 vs. 57.49%) and Stage IIIA (26.98 vs. 6.18%) by the log rank test and Breslow test. There was no significant yet marginal difference in survival by log rank test (10-year survival 32.04 vs. 26.92%, P=0.0523) but significant difference in survival by Breslow test (5-year survival 50.42 vs. 34.05%, P=0.0284) in Stage II. Types of mediastinal lymph node dissection, pTNM stage, tumor size and number of lymph node metastasis were four factors that influenced long-term survival rate by multivariate analysis.
  
  
  CONCLUSIONS
  As compared with MLS, lobectomy (pneumonectomy) combined with SND can improve survival in resectable NSCLC.
authors.affiliation: Lung Cancer Research Center, 3rd University Hospital, Sun Yat-sen University of Medical Sciences, Guangzhou 510630, PR China. gzyilong@public.guangzhou.gd.cn
authors.forename: Yi long
authors.initials: Yl
authors.lastname: Wu
authors.forename: Zhi-fan
authors.initials: ZF
authors.lastname: Huang
authors.forename: Si-yu
authors.initials: SY
authors.lastname: Wang
authors.forename: Xue-ning
authors.initials: XN
authors.lastname: Yang
authors.forename: Wei
authors.initials: W
authors.lastname: Ou
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008482:Mediastinum / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011446:Prospective Studies; D015996:Survival Rate