Dual intervention to improve pathologic staging of resectable lung cancer.
BACKGROUND
Detection of lymph node metastasis is of immense prognostic value in patients with resectable non-small cell lung cancer (NSCLC), but routine pathologic nodal staging is suboptimal. To determine the impact on the rate of detection of nodal metastasis, we tested dual intervention with a prelabeled lymph node specimen collection kit to improve intraoperative node dissection and a fastidious gross dissection of the lung resection specimen for intrapulmonary lymph nodes.


METHODS
We matched dual-intervention cases with controls staged using standard surgical specimen collection and pathologic examination protocols. Controls were hierarchically matched for extent of resection, laterality, surgeon, pathologist, and T stage. All statistical comparisons were made with exact conditional logistic regression, to account for the matched case-control design.


RESULTS
One hundred dual-intervention cases were matched with 100 controls. The dual interventions resulted in approximately a 3-fold increase in the number of lymph nodes examined and the number of lymph nodes with metastasis detected; they also increased the proportion of patients with lymph node metastasis from 21% to 35% (p = 0.02). There were strong trends toward higher aggregate stage distribution, and eligibility for postoperative adjuvant chemotherapy in the dual-intervention cases.


CONCLUSIONS
The combination of interventions improved the thoroughness and accuracy of pathologic nodal staging. A prospective randomized trial to test the survival impact of the dual interventions is warranted.
Thoracic Oncology Research (ThOR) Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee. Electronic address: rosarogi@bmg.md.
Raymond U
RU
Osarogiagbon
Robert A
RA
Ramirez
Christopher G
CG
Wang
Laura E
LE
Miller
Matthew M
MM
Smeltzer
Srishti
S
Sareen
Ahmed Y
AY
Javed
Samuel G
SG
Robbins
Alim
A
Khandekar
Bradley A
BA
Wolf
Jeffrey
J
Gibson
David
D
Spencer
Edward T
ET
Robbins
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D009367:Neoplasm Staging / Q000639:trends*; D011013:Pneumonectomy / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
10; ACOSOG; American College of Surgeons Oncology Group; Chemo; ECOG; ESTS; Eastern Cooperative Oncology Group; European Society of Thoracic Surgeons; IQR; NCCN; NSCLC; National Comprehensive Cancer Network; PET/CT; SD; TNM; XRT; ambiguous pathologic nodal stage because of no examination of lymph nodes; interquartile range; non–small cell lung cancer; pN1; pN2; pNX; pathologic N1; pathologic N2; positron emission tomography/computed tomography; postoperative adjuvant chemotherapy; postoperative adjuvant radiation therapy; standard deviation; tumor, node, metastasis staging system