title: Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules.
abstract: 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.
  
  
  
  Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules.
  
  
  
  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.
  
  
  
  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).
  
  
  
  It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.
authors.affiliation: *Departments of Thoracic Surgery and Radiology, Mount Sinai School of Medicine, New York, NY †Department of Surgery, Christiana Care, Helen F. Graham Cancer Center, Newark, DE ‡Department of Surgery, Swedish Medical Center, Seattle, WA §Department of Surgery, South Nassau Communities Hospital, Long Island, NY ¶Department of Surgery, Upstate Medical Center, Syracuse, NY ||Deprtment of Surgery, Mills-Peninsula Health Services, San Mateo, CA **Department of Surgery, Wellstar Health System, Marietta, GA ††Department of Surgery, Jackson Memorial Hospital, University of Miami, Miami, FL ‡‡Department of Surgery, The Valley Hospital Cancer Center, Paramus, NJ §§Department of Surgery, John Muir Cancer Institute, Concord, CA ¶¶Department of Surgery, City of Hope National Medical Center, Duarte, CA ||||Department of Surgery, New York University Medical Center, New York, NY ***Department of Surgery, Beth Israel Hospital Center, New York, NY †††Department of Medicine, Weill Cornell Medical College, New York, NY ‡‡‡Phoenix Veterans Health Care System, Phoenix, AZ §§§Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
authors.forename: Daniel
authors.initials: D
authors.lastname: Nicastri
authors.forename: Thomas
authors.initials: T
authors.lastname: Bauer
authors.forename: Ralph
authors.initials: R
authors.lastname: Aye
authors.forename: Shahriyour
authors.initials: S
authors.lastname: Andaz
authors.forename: Leslie
authors.initials: L
authors.lastname: Kohman
authors.forename: Barry
authors.initials: B
authors.lastname: Sheppard
authors.forename: William
authors.initials: W
authors.lastname: Mayfield
authors.forename: Richard
authors.initials: R
authors.lastname: Thurer
authors.forename: Robert
authors.initials: R
authors.lastname: Korst
authors.forename: Michaela
authors.initials: M
authors.lastname: Straznicka
authors.forename: Fred
authors.initials: F
authors.lastname: Grannis
authors.forename: Harvey
authors.initials: H
authors.lastname: Pass
authors.forename: Cliff
authors.initials: C
authors.lastname: Connery
authors.forename: Rowena
authors.initials: R
authors.lastname: Yip
authors.forename: James P
authors.initials: JP
authors.lastname: Smith
authors.forename: David F
authors.initials: DF
authors.lastname: Yankelevitz
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Henschke
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome