Seth B Krantz1, Waseem Lutfi2, Kristine Kuchta3, Chi-Hsiung Wang3, Ki Wan Kim4, John A Howington5. 1. Department of Surgery, NorthShore University Health System, Evanston, Illinois; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Electronic address: skrantz@northshore.org. 2. Department of Surgery, NorthShore University Health System, Evanston, Illinois. 3. Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, Illinois. 4. Department of Surgery, NorthShore University Health System, Evanston, Illinois; Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois. 5. Division of Thoracic Surgery, Saint Thomas Healthcare, Nashville, Tennessee.
Abstract
BACKGROUND: Lymph node assessment for non-small cell lung cancer (NSCLC) shows wide variation among centers. Our aim was to assess the quality of lymph node assessment in early-stage NSCLC and determine whether any factors are associated with improved lymph node harvest. METHODS: We queried the National Cancer Database to identify patients with clinical stage I NSCLC who underwent segmentectomy or lobectomy between 2004 and 2013. Patients were stratified into three groups (≤5, 6 to 15, and >15) based on the number of lymph nodes assessed. RESULTS: Patients (n = 51,358) met criteria, and mean lymph nodes assessed increased from 8.1 to 10.0 (p < 0.001) over the study period. There was a significant decrease in the percentage of patients with 0 to 5 nodes assessed (41.1% versus 31.1%, p < 0.001) and a significant increase in patients with more than 15 nodes assessed (10.1% versus 17.0%, p < 0.001). Patients at academic centers were less likely to have only 0 to 5 nodes assessed (27.2% versus 43.6% for community, p < 0.001). Variables associated with more than 15 nodes assessed were increasing year, age older than 65 years, male sex, non-African American race, academic centers, lobectomy, and clinical T2 disease. Patients with more than 14 nodes assessed demonstrated more nodal upstaging (17.9% versus 10.9% for 1 to 14 nodes, p < 0.001). Multivariable analysis suggests that at least 14 nodes should be assessed to maximize the probability that node-positive patients are correctly identified. CONCLUSIONS: Lymph node assessment has improved since 2004 but varies by facility type and other characteristics. In our analysis removing at least 14 nodes was associated with more accurate staging.
BACKGROUND: Lymph node assessment for non-small cell lung cancer (NSCLC) shows wide variation among centers. Our aim was to assess the quality of lymph node assessment in early-stage NSCLC and determine whether any factors are associated with improved lymph node harvest. METHODS: We queried the National Cancer Database to identify patients with clinical stage I NSCLC who underwent segmentectomy or lobectomy between 2004 and 2013. Patients were stratified into three groups (≤5, 6 to 15, and >15) based on the number of lymph nodes assessed. RESULTS:Patients (n = 51,358) met criteria, and mean lymph nodes assessed increased from 8.1 to 10.0 (p < 0.001) over the study period. There was a significant decrease in the percentage of patients with 0 to 5 nodes assessed (41.1% versus 31.1%, p < 0.001) and a significant increase in patients with more than 15 nodes assessed (10.1% versus 17.0%, p < 0.001). Patients at academic centers were less likely to have only 0 to 5 nodes assessed (27.2% versus 43.6% for community, p < 0.001). Variables associated with more than 15 nodes assessed were increasing year, age older than 65 years, male sex, non-African American race, academic centers, lobectomy, and clinical T2 disease. Patients with more than 14 nodes assessed demonstrated more nodal upstaging (17.9% versus 10.9% for 1 to 14 nodes, p < 0.001). Multivariable analysis suggests that at least 14 nodes should be assessed to maximize the probability that node-positive patients are correctly identified. CONCLUSIONS: Lymph node assessment has improved since 2004 but varies by facility type and other characteristics. In our analysis removing at least 14 nodes was associated with more accurate staging.