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| |  Number of Evaluated N1 Nodes Impacts Survival in NSCLC: Presented at STS By Charlene Laino FORT LAUDERDALE, Fla -- January 28, 2010 -- Removal and evaluation of 21 or more N1 lymph nodes positively impact patient survival following resection for non-small-cell lung cancer (NSCLC), researchers reported here at the Society of Thoracic Surgeons (STS) 46th Annual Meeting. Akif Turna, MD, Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey, reported the findings here on January 26. While mediastinal lymph node dissection has been proven to be essential in surgery for NSCLC, there is continued controversy regarding the number of lymph nodes that need to be removed and evaluated for proper staging or therapeutic purposes, according to Dr. Turna. The current study aimed to analyse the impact of the number of resected and evaluated N1 nodes on survival in patients who underwent resectional surgery for non-small-cell lung cancer. The researchers conducted a retrospective review of 979 consecutive patients who underwent resectional surgery for NSCLC between January 1998 and August 2008. The mean age of the patients, 911 of whom were male, was 57 years. A total of 58% of patients underwent lobectomy, 31% underwent pneumonectomy, 10% had bilobectomy, and the rest had segmentectomy or wedge resection. All patients underwent systematic mediastinal lymph node dissection along with dissection of hilar and interlobar lymph nodes. Patients were followed up for a mean of 26 months. The surgical mortality rate was 4.4%, and the overall survival rate was 54.7%. The mean number of resected mediastinal lymph nodes was 8.1, and the mean number of evaluated N1 nodes was 10.2. The 5-year survival rate was 56% in patients in whom <21 N1 nodes were evaluated, compared with 83% in patients >=21 N1 nodes analysed; however, the difference was not statistically significant (P = .36). “In lobectomy patients, however, survival was longer if the number of evaluated N1 nodes was over 20,” said Dr. Turna, citing a P value of .03. The researchers then looked at the impact of the number of evaluated N1 nodes on survival for all patients in a multivariate model adjusted for stage, histology, and gender. Results showed that patients in whom <21 N1 nodes were evaluated were 24% more likely to die, compared with patients in whom more N1 nodes were analysed (P = .03). There appeared to be no incremental improvement in survival rates with evaluation of more than 21 lymph nodes, Dr. Turna said. Dr. Turna said the mechanism of action of the findings remains unknown and merits further study. “It could be due to better staging and/or better clearance of the lymphatic pathway or other actions altogether. Further study is needed.” [Presentation title: The Impact of Number of Evaluated N1 Nodes on the Survival of Resected Patients With Non-Small Cell Lung Cancer. Abstract 71]
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