The significance of systematic lymph node dissection in surgery for early-stage non-small cell lung cancer patients aged ≤40 years

Zhi-Yi Guo; Jiang-Hao Ren; Yuan-Yuan Xu; Rui-Jun Liu; Hui Tao; Jia Huang; Qiang Tan

doi:10.21037/jtd-21-190

The significance of systematic lymph node dissection in surgery for early-stage non-small cell lung cancer patients aged ≤40 years

J Thorac Dis. 2021 Feb;13(2):1196-1204. doi: 10.21037/jtd-21-190.

Authors

Zhi-Yi Guo¹, Jiang-Hao Ren¹, Yuan-Yuan Xu¹, Rui-Jun Liu¹, Hui Tao¹, Jia Huang¹, Qiang Tan¹

Affiliation

¹ Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.

Abstract

Background: Surgery remains the best option for treating early-stage non-small cell lung cancer (NSCLC), and lymph node dissection (LND) is an important step in this approach. However, the extent of LND in the general age population, especially in young patients, is controversial. This retrospective study aimed to investigate the correlation between systematic lymph node dissection (SLND) and prognosis in young (≤40 years) patients with stage IA NSCLC.

Methods: Clinicopathological data of 191 patients aged ≤40 years who underwent surgical pulmonary resection for stage IA NSCLC between January 2010 and December 2016 were retrospectively collected. Of the patients, 104 received SLND (SLND group), while the other 87 patients underwent sampling or no LND (non-SLND group). The disease-free survival (DFS) and overall survival (OS) curves of the patients from each group were plotted using the Kaplan-Meier method, and the correlations of the patients' clinical factors with prognosis were also analyzed.

Results: The median follow-up period was 55 months. During follow-up, 7 patients died, and recurrence or metastasis was detected in 16 patients. Kaplan-Meier analysis revealed no difference in DFS (P=0.132) between the SLND and non-SLND group, but a significant difference was found between the groups in OS (P=0.022). Additionally, there was no statistically pronounced difference in OS or DFS between male and female patients. Multivariate survival analysis showed that the type of SLND, as well as tumor size, is an independent prognostic factor for DFS (HR, 3.530; 95% CI, 1.120-11.119; P=0.031) and OS (HR, 13.076; 95% CI, 1.209-141.443; P=0.034).

Conclusions: For young (age ≤40) stage IA NSCLC patients with pathological invasive adenocarcinoma, intraoperative SLND can improve the DFS and OS. Further studies are needed to verify the most optimal degree of LND in young patients.

Keywords: Early-stage non-small cell lung cancer (early-stage NSCLC); lymph node dissection; prognosis; young patients.