Raymond U Osarogiagbon1, Paul A Decker2, Karla Ballman3, Dennis Wigle4, Mark S Allen4, Gail E Darling5. 1. Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee. Electronic address: rosarogi@bmhcc.org. 2. Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota. 3. Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York. 4. Department of Surgery, Mayo Clinic, Rochester, Minnesota. 5. Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Accurate pathologic nodal staging mandates effective collaboration between surgeons and pathologists. The American College of Surgeons Oncology Group Z0030 trial (ACOSOG Z0030) tightly controlled surgical lymphadenectomy practice but not pathologic examination practice. We tested the survival impact of the thoroughness of pathologic examination (using the number of examined lymph nodes as a surrogate). METHODS: We re-analyzed the mediastinal lymph node dissection arm of ACOSOG Z0030, using logistic regression and Cox proportional hazards models. RESULTS: Of 513 patients, 435 were pN0, 60 were pN1, and 17 were pN2. The mean number of mediastinal lymph nodes examined was 13.5, 13.1, and 17.1; station 10 lymph nodes were 2.4, 2.7, and 2.6; station 11 to 14 nodes were 4.6, 6.1, and 6.7; and total lymph nodes were 19.7, 21.3, and 25.4 respectively. The pN category and histologic evaluation were associated with increased number of examined intrapulmonary lymph nodes. Patients with pN1 had more non-hilar N1 nodes than patients with pN0, patients with N2 had more N2 nodes examined than patients with pN0 or pN1. Patients with pN0 had better survival with examination of more N1 nodes; patients with pN1 had better survival with increased mediastinal nodal examination; the likelihood of discovering N2 disease was significantly associated with increased examination of mediastinal and non-hilar N1 lymph nodes. CONCLUSIONS: Despite rigorously standardized surgical hilar/mediastinal lymphadenectomy, the number of lymph nodes examined was associated with the likelihood of detecting nodal metastasis and survival. This may indicate an effect of incomplete pathologic examination.
BACKGROUND: Accurate pathologic nodal staging mandates effective collaboration between surgeons and pathologists. The American College of Surgeons Oncology Group Z0030 trial (ACOSOG Z0030) tightly controlled surgical lymphadenectomy practice but not pathologic examination practice. We tested the survival impact of the thoroughness of pathologic examination (using the number of examined lymph nodes as a surrogate). METHODS: We re-analyzed the mediastinal lymph node dissection arm of ACOSOG Z0030, using logistic regression and Cox proportional hazards models. RESULTS: Of 513 patients, 435 were pN0, 60 were pN1, and 17 were pN2. The mean number of mediastinal lymph nodes examined was 13.5, 13.1, and 17.1; station 10 lymph nodes were 2.4, 2.7, and 2.6; station 11 to 14 nodes were 4.6, 6.1, and 6.7; and total lymph nodes were 19.7, 21.3, and 25.4 respectively. The pN category and histologic evaluation were associated with increased number of examined intrapulmonary lymph nodes. Patients with pN1 had more non-hilar N1 nodes than patients with pN0, patients with N2 had more N2 nodes examined than patients with pN0 or pN1. Patients with pN0 had better survival with examination of more N1 nodes; patients with pN1 had better survival with increased mediastinal nodal examination; the likelihood of discovering N2 disease was significantly associated with increased examination of mediastinal and non-hilar N1 lymph nodes. CONCLUSIONS: Despite rigorously standardized surgical hilar/mediastinal lymphadenectomy, the number of lymph nodes examined was associated with the likelihood of detecting nodal metastasis and survival. This may indicate an effect of incomplete pathologic examination.
Authors: Robert A Ramirez; Christopher G Wang; Laura E Miller; Courtney A Adair; Allen Berry; Xinhua Yu; Thomas F O'Brien; Raymond U Osarogiagbon Journal: J Clin Oncol Date: 2012-07-09 Impact factor: 44.544
Authors: Raymond U Osarogiagbon; Robert A Ramirez; Christopher G Wang; Laura E Miller; Laura McHugh; Courtney A Adair; Matthew P Smeltzer; Xinhua Yu; Allen Berry Journal: Ann Diagn Pathol Date: 2014-02-10 Impact factor: 2.090
Authors: Gail E Darling; Mark S Allen; Paul A Decker; Karla Ballman; Richard A Malthaner; Richard I Inculet; David R Jones; Robert J McKenna; Rodney J Landreneau; Valerie W Rusch; Joe B Putnam Journal: J Thorac Cardiovasc Surg Date: 2011-03 Impact factor: 5.209
Authors: Gail E Darling; Mark S Allen; Paul A Decker; Karla Ballman; Richard A Malthaner; Richard I Inculet; David R Jones; Robert J McKenna; Rodney J Landreneau; Joe B Putnam Journal: Chest Date: 2010-09-09 Impact factor: 9.410
Authors: Raymond U Osarogiagbon; Jeffrey W Allen; Aamer Farooq; Allen Berry; Thomas O'Brien Journal: Ann Thorac Surg Date: 2011-05 Impact factor: 4.330
Authors: Qian Li; Ping Zhan; Dongmei Yuan; Tangfeng Lv; Alexander Sasha Krupnick; Antonio Passaro; Alessandro Brunelli; Matthew P Smeltzer; Raymond U Osarogiagbon; Yong Song Journal: Transl Lung Cancer Res Date: 2016-06
Authors: Meredith A Ray; Nicholas R Faris; Matthew P Smeltzer; Carrie Fehnel; Cheryl Houston-Harris; Paul Levy; Lynn Wiggins; Vishal Sachdev; Todd Robbins; David Spencer; Raymond U Osarogiagbon Journal: Ann Thorac Surg Date: 2018-03-11 Impact factor: 4.330